Starting a Medical Billing Business > Starting Your Own Medical Billing Business
Negotiating contracts
midwifebiller:
We just welcomed our largest client yet and the best part is--they are contracted with all of the major payers. (95% of our clients are OON , so this will be a bit different for us.) They were told by their previous biller that their contracted rates are too low and that they should renegotiate the contracts.
I am ready to learn how to negotiate fees. I am very familiar with the midwife model of care and have spoken to many Provider Service reps and Medical Directors regarding equitable reimbursement rates for midwives, but it has always been in general OON terms, not with a contract. Where do I go to learn the nitties and gritties of negotiation?
Thanks!
~Kelli
PMRNC:
1st make sure the practice has an attorney, if they don't you could private contract with one. You do NOT want to negotiate contracts/fees without an experienced contract attorney unless you have done this for a while.
2nd, find a course to take if you don't have time to self - study and learn. I have done credentialing for years before I ventured into contract and fee schedule's negotiations, I also took college courses in contract law and obtained my paralegal. There are even small things you pick up such as what to do if the carrier tells you they don't negotiate (many will tell you that), just from experience doing it. There are also formula's and data gathering you will need to do and very strict guidelines about discussing fees with other providers. (some will try to do this to see if they can get same rate and it puts both providers at risk)
It's really not as easy as just jumping into it, What I did when I started was I stuck with the carrier negotiations and then let the attorney sign off and review..If I used MY attorney they would bill the client and I would bill for my work, the lawyer just becomes a private contract.
midwifebiller:
Thanks, Linda.
I have a good contract attorney and they have their own attorney, too. We have a local community college and I will check the classes they offer on legal matters, especially contract law. Is there a course or two on insurance contract negotiation that you can recommend?
Pay_My_Claims:
i didn't know they had classes for that..........i have to see what they have close to me or online. i have done it before, but not frequently
blhoffman:
I found this article on medical contract neg. and thought it was very helpful and interesting.
http://www.acpinternist.org/archives/1999/06/troublespts.htm
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