Negotiating contracts

[stim4u]

Hello:

Starting a practice soon. I was interested in the boards opinion on hiring a practice negotiator/liason (estimates 10-30K) versus using a billing company willing to offer set-up services. Furthermore, how much will commercial insurance companies negotiate in terms of medication costs (ie. contrast, steroid)/tray costs, etc? Or is it better to perform as many of these duties myself to understand the nuts and bolts. Thanks for you time.

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[Aether2000]

If you are solo, it is unlilkely there will be any "negotiation" of contracts. The insurers have preset panels of prices and do not make special arrangements in most cases for solo practitioners. If it were me, I would save my money on the consultant....

 

[indytravl]

I was told that a termination clause was not put in a contract because it was only a 2 year one. Has anyone heard of that? Is it standard practice?

thanks, [email protected]

 

[aebilling1]

Hello there!

I own a billing company and have also worked in medical offices for years. If you are going with a billing company, see if you can find one that will help you with contracts. It is kinda rare to find. A lot of folks don't understand how the contracting stuff works. It is not difficult, but you do have to be on top of it.

I have personally helped providers renegotiate contracts for better rates. I have seen a lot of success with this. However, a lot depends on your specialty and geographic area. For example, I had one surgeon who was the only specialist of his kind in a 150 mile radius. He was a solo doc. It was easy to negotiate for better rates, especially surgical rates. We were able to go to 130% of current Medicare rates, which is pretty good for a major PPO carrier who normally does not negotiate. In addition, we were able to "carve out" a subsection of codes for his specialty, and get those codes at a rate of 140% of current Medicare. In this case, the carrier wanted the docs business in that locality. Otherwise, the patients would still see that doc and use "out of network" benefits, which sometimes can actually yield higher payments to the providers. It was in the carrier's interest to negotiate a contract and avoid non network processing of claims.

There are some carriers out there that will negotiate. It can be done. Of course, there are some that won't. You just have to have someone agressive enough to find out.

As far as supply reimbursement, I wouldn't worry much about the smaller supplies and such. Some carriers don't cover them at all. Some do. The rates are usually piddly. However, if you are an orthopod injecting hyalgan or synvisc, you want to make sure you are covering your cost for those expensive items. I would look into a "carve out" situation for those.

Also, in looking at reimbursement rates, beware of the wording of the contract. Some contracts will offer you 105% of Medicare. However, they don't tell you which year of Medicare. That makes a difference. Are they basing the rates on the current year's Medicare rates or 2001, for example. The rates generall are going down each year, but in specialty coding, you have to really look at some of the specific codes. In some instances, the newer rates are higher than they were years ago. It is important to check this. Also, there are different geographic regions for Medicare rates. Gotta check that, too.

I personally think that physicians need to know what is involved in contracting and should be informed of what is going on. However, it is not necessary for a physician to sit there and fill out all the dumb paperwork and all that. Find a billing service that will do that for you...heck, even your receptionist can fill in the blanks and you can review it....etc.

If you have any more questions, don't hesitate to ask! I can be reached at [email protected].

Good luck!

Elizabeth Williams
A&E Billing Solutions, LLC
Livermore, CA

 

[Aether2000]

Yada, yada, yada....and it cost the physician $10K-$30K to find out if a contract can be negotiated by consultants.....forget these consultants. They make their money by promising the moon but take no responsibility when they can't deliver. If they were serious and confident about their abilities, they would offer a zero rate to the physician unless they can negotiate a substantially better contract for the physician. Beware of advice coming from those who are overtly advertising their services on a student forum...

 

[aebilling1]

I'd say offering a zero rate to the physician unless they can negotiate a substantially better contract for the physician is a good way to go.

I apologize if anyone is offended by my post. I can assure you that the point in letting folks know about my background and line of work is so that folks will know I am experienced. Believe it or not, I do enjoy giving advice and offering suggestions, in an effort to help physicians succeed. I have watched physicians struggle with the battle for payment from insurance carriers for many years. My business is doing very well and if I solely wanted to advertise, I would place an ad somewhere! Again, I apologize if anyone is offended.

 

[Aether2000]

We are not offended but are suspicious of the motives of one who lists their contact telephone number under their business name...sorry, but those of us who have been in pain management for 20 years know enough to be cautious when dealing with salespeople. If you want to legitimize your posts, drop the billing address and telephone number, and simply go by your moniker...

 

[aebilling1]

Got it! Thanks!

 

[stim4u]

Hello again:

I would like to thank Algosdoc and aebilling for your input. This forum is full of useful information. I will perform most of the necessary credentialing and negotiations, maybe use my billing company for the top 3 insurance companies for reference purposes.

Two more questions for you. I heard that medicare bundles a CPT code for performing discography (in a facility) and that a fluoro modifier cannot be used. Is this true, and if such a procedure is performed in a private setting can the fluro modifier be used? Also, Algosdoc do you bill as lumbar sympathetic blocks when performing a hypogastric block, as there is a small fee difference.

Thanks

 

[drusso]

Elizabeth,

Technically, it is a violation of the SDN User Agreement to advertise professional services on these forums. These are, first and foremost, educational and professional development forums. Please respect that it has to be this way for legal reasons related to SDN's non-profit status.

SDN Terms of Service FAQ

You are more than welcome to become a formal SDN sponsor and formally purchase advertising space to promote your company's services. You are more than welcome to provide generic advice to those posting here without explicitly advertising your services or company, but by conscientiously stating your conflict of interest in the matter and not solicit potential clients.

Because I think that most residents and fellows posting here have a sincere interest in these issues, I invite you to keep posting and contributing to the conversation as appropriate. However, I and other moderators will be monitoring your posts closely...as will some of the other more vocal and experienced users of this forum.

 

[f_w]

I actually find it useful to get the perspective of a billing company person on here. By providing her company affiliation, anyone reading the forum can form his/her own opinion about the value/bias of the information provided.

Re-reading her post, on the balance it contains more information than advertising. She didn't say 'hire me', rather 'consider hiring someone'.

 

[drusso]

I actually find it useful to get the perspective of a billing company person on here. By providing her company affiliation, anyone reading the forum can form his/her own opinion about the value/bias of the information provided.

Re-reading her post, on the balance it contains more information than advertising. She didn't say 'hire me', rather 'consider hiring someone'.

I agree. Just making clear the rules of the road.

 

[aebilling1]

Thanks f_w for your support. And thank you drusso for spelling out the rules. I have removed my location and phone number from my "signature" so hopefully that will help avoid any assumptions that I am selling my services. I will also make it clear in any future posts, should I choose to even post again, that I am passing on personal experiences and not a solicitation for services. If folks wish to contact me off the board, that is fine. I know, after being in this industry for 15 years that there is a lack of reliable resources in the billing arena. I have always tried to be a voice for providers and other folks in my industry, so that we, as a whole, can stay on top of the game. Billing is not rocket science, but it is complex. The rules are ever changing. It is difficult for even a seasoned verteran to stay on top of things. I enjoy helping others and, anytime I can learn something from others, I appreciate that, as well. Although I certainly respect the rules, it is too bad that a single post or two can automatically generate assumptions and labels.