Author Topic: Negotiating Reimbursements Fees  (Read 1217 times)

macbook

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Negotiating Reimbursements Fees
« on: October 12, 2011, 03:55:05 AM »
Hello again,

As a billing company, exposed to multiple provider groups' reimbursement fees, we would like to  start negotiating for increased reibursement with their respective  insurances. Are we in breach of the anti-trust law if we do this?

Thanks for your help.  I am also hoping Alice could write another book or artilce on negotiating contracts with networks and payors. :) 

Thank you,

PMRNC

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Re: Negotiating Reimbursements Fees
« Reply #1 on: October 12, 2011, 06:45:29 AM »
No, there are still quite a few carriers who will negotiation, key is to have all your ducks in a row, specialty and statistics on area provider's services, etc.  And also you should NOT complete the process without an attorney to sign off on the contracts! Either require the provider to have on on retainer or have one yourself.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

macbook

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Re: Negotiating Reimbursements Fees
« Reply #2 on: October 13, 2011, 06:19:01 PM »
Thanks Linda. I appreciate it.

United Healthcare is really one of those who don't even bother replying to our request for negotiations. :(. I then thought, maybe, I am not doing it right. :)

 Well, I guess I will stay away from negotiating fees for now since it really is just an added headache. Plus an added expense to either myself or to our clients, if I need a lawyer to look into it.

I really appreciate your reply.

Thank you.

PMRNC

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Re: Negotiating Reimbursements Fees
« Reply #3 on: October 25, 2011, 08:33:54 AM »
One of things carriers look for to open negotiations is marketability from their prospective.. they like provider's who have a service other providers in the area may not have, they look at that first. That's just ONE of things they look to first before negotiations. There are carriers who "across the board" will NOT negotiate in certain areas, this is where the attorney really is needed and not just to go over the contracts, as they can determine if a carrier is within their right to NOT negotiate based on geographic location, services, etc.  A LOT goes into credentialing at this level.. if you decide to do it you need to really charge a decent fee to recoup your time. It's a lot of work but it can also be a great service to your larger providers. (I don't normally do this for solo or very small specialty groups as they often don't want to pay the higher fees to do so)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com