Medical Billing Forum

Payments => Insurance Payments => Topic started by: pvtbiller on May 02, 2012, 08:28:47 PM

Title: Medicare being the lowest payer
Post by: pvtbiller on May 02, 2012, 08:28:47 PM
Does anyone know if this is still "true"... Does Medicare have to be the lowest payer?  I am in the process of contracting with a private/commercial insurance company and they want to know how much of a discount we can give them off of the Medicare allowable.  Does this hold true?  Can I negotiate below a Medicare allowable with private insurance carriers or must Medicare be the lowest payer?
Title: Re: Medicare being the lowest payer
Post by: Michele on May 03, 2012, 06:52:01 AM
I personally don't do negotiations but just wanted to weigh in on this.  Medicare is not the lowest payer with most of the providers we are billing for.  I see many with lower reimbursements. 
Title: Re: Medicare being the lowest payer
Post by: PMRNC on May 03, 2012, 08:42:34 AM
I agree with Michele, Medicare is NOT the lowest payer at all. I've seen much lower. Medicare is also the EASIEST and least stringent and easiest to bill, anyone that says otherwise, I'd have to ask WHY?   

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Can I negotiate below a Medicare allowable with private insurance carriers or must Medicare be the lowest payer?
Yes/no, you can negotiate with private payors depending on the carrier, some will not negotiate as an overall rule. Negotiations really are not based on Medicare allowable on a higher/lower ratio..but the allowable are used as a base...HOWEVER..this could backfire if you already have a contract and the allowable is higher. Negotiating fee schedules should only be done by someone who is experienced and it's not just the fees, the contract is negotiated as well and the person doing the negotiations need have an attorney on hand to review or have extensive experience with managed care contracts! It's not as easy as it sounds and can be very time consuming as well as frustrating. It's especially frustrating when the provider is serious about wanting to get higher reimbursements, but doesn't want to pay the costs associated with it such as the consulting/credentialing rates of person conducting the negotiations and the legal expenses of reviews of the contracts. Though the cost can be high, over a period of time it benefits the practice in most cases. In some cases it may not result in desired effects.  There are also specialties which are much more difficult to negotiate even with limited amounts of codes such as psychiatry.
Title: Re: Medicare being the lowest payer
Post by: pvtbiller on May 03, 2012, 09:07:02 AM
Thank you