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    Fighting for higher payer rates is worth the effort

     

    He adds that the only increases he saw as a family practitioner were the result of joining a provider organization that negotiated on behalf of all small practices on Michigan’s Upper Peninsula.

    Because of these real and perceived difficulties, practices can go many years without a payment increase, even as their own expenses rise. The good news is that it is possible, in some instances, to negotiate higher fees. The bad news is that it’s quite difficult.

    Data as a weapon

    Because it involves insurance companies, it should be no surprise that fighting involves a lot of paperwork. Payers don’t respond to emotional appeals, so practices have to arm themselves with data.

    Top 12 worst and best paying states for internists

    Before approaching an insurer, a practice should conduct an internal audit, says Melody Irvine, CPC, CPMA, a practice consultant and owner of Career Coders in Loveland, Colorado. That means pulling all current and past contracts as well as years of payment records from insurers.

    A practice needs to know how much it makes or loses on each contract, how much business it does with each payer, how many patients are covered by each insurer, which CPT codes it bills most often under each contract, the reimbursement for those codes and how the payments have changed over the years, if at all.

    Next: Not having enough time isn't a good excuse

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