It’s a sign of the times: The twin tides of rising regulation and declining reimbursement have forced remaining independent practices to run a tighter ship or be swallowed up by integrated systems or hospitals.
The first rule of running a tighter ship is getting your hands dirty with payer contracting, according to
expert advice from McKesson’s healthcare consulting division. “Often, we find that the reason behind declining revenues doesn’t have to be uncovered – it’s right there in plain sight in your payer contracts,” writes Rob Saunders, MHA, director of consulting for McKesson.
While big corporate payers like Aetna, UnitedHealth and Anthem rely on sophisticated analytics and databases to create contracts favorable to their bottom lines, many physicians are operating in prehistoric times.
“Our experience has shown that … people are often uncomfortable with the whole process,” Saunders writes. “They don’t have the expertise and skills to confidently analyze issues related to changes in relative value years, percentages, RVUs, etc.”
Without such analysis, it’s difficult to make good business decisions, Saunders points out. His advice? First, make sure you validate your received payments against the rates in your contract – creating a fee schedule for each contract can be a handy way to do that. Second, analyze the best Medicare fee schedule rates for your practice and top-billed procedures and negotiate based on it.