This sample letter will serve as a great tool for your practice when going to renegotiate your reimbursement rates with your private payer.  You can use the letter, in PDF format,  as a guide when writing your own renegotiation letter, says the letter's author Brian Agnew, president of Supero Healthcare Solutions in Austin, Texas.

The key: Your letter should be straightforward and brief, no more than two pages, dictating what you want to renegotiate and a glimpse of why your practice is important to the payer and the leverage it can offer, experts say (PBN 10/31/11). The key is to explicitly say what you want to do without tipping your hand, Agnew says.

It’s up to you to start negotiation talks with your payer and get a rate increase. But to get the ball rolling in your favor, you must approach your payer in the right way and be persistent. For example, start by trying to schedule a casual chat with them to issue a head’s up that you want to renegotiate your contract, experts say.

This chart looks at 10 lab codes that saw significant utilization growth from 2009 to 2010, and also had a high denial rate (classified as 10% or above). NOTE: Codes with low utilization or total reimbursement were excluded from analysis. Medicare claims data for clinical labs was eliminated, so this data reflects lab codes billed primarily by physicians and non-physician providers (NPPs).

We have a patient who comes in for allergy testing and then leaves the office with a vial of medicine for injection for the allergies. Medicare will only pay for one service per day. What modifiers and codes should be used?

Your non-physician practitioners (NPPs) are raking in more E/M income than any previous year, according to an exclusive NPP Report analysis of the latest Medicare claims data from 2010, the first year CMS stopped taking consultation codes (99241-99255). Remember: NPPs are permitted to bill consults so long as they are not billed incident-to, which would require a physician-initiated plan of care.

Your non-physician practitioners’ (NPPs) incident-to billing practices are a top target on the HHS’ Office of Inspector General (OIG) 2012 WorkPlan, which meansyour NPPs must be extremely careful when billing these services. NPPs are invisible on incident-to claims which is why it is so important to make sure a service musters up to the criteria, says Dianne Wilkinson, RHIT, a compliance auditor at West Tennessee Healthcare in Jackson, Tenn.