There are many ways that a medical practice can improve on the performance of its payors. Establishing some best practices for your payors might be the best method to insure that a steady stream of cash flows into your accounts each month.
Following are three techniques that can help ensure that this crucial part of your practice stays healthy.
Seek Out Strong Payors: Many practices work with as many insurance companies as possible. This allows flexibility for patients and in fact, may increase patient count because of that. The expectation is that the volume will compensate for lower payor rates.
However, some experts recommend that a practice work with just a few (one to three) preferred payors and construct a patient base around them.
Initially, this may appear to be unappealing. However, there is something to be said for selecting a few above average payors who the practice can develop a strong and mutually beneficial relationship with. The more desirable the insurance plans the more efficient and cash healthy medical practice.
Negotiate Rates: Insurance company pay rates usually renew annually. Even though renewal dates may fall at different times of the year for all of the companies, it is a good idea to compare all payors when one is up for renewal. To do this easily, prepare a spreadsheet containing all of the practice insurance company rates and monitor it closely.
However, it is easiest to negotiate with insurance companies during the renewal period. When negotiating use data from clinic expenses, prior increases and market conditions to prepare a case for increasing fees. Negotiate face-to-face if possible. If not, use email to follow up and document phone conversations.
Sometimes, just the awareness that the practice brings to payors goes a long way to obtaining the rate adjustments needed.
Review Payments: A better word might be auditing the payments. The outcome could be very advantageous. Auditing ensures that claims being paid by the insurance company are being paid correctly and on time by comparing the payments to the negotiated rates and payment schedules.
In fact, without payment auditing, how could a practice ever be sure that all of its incoming funds are being collected as they should be?
The best way to audit is to rely on practice and revenue management software that automatically compares each individual line item payment application to the negotiated rate. Then, any discrepancies are flagged and noted on a report for action to be taken.