Before demanding higher rates from your payers, you must have leverage – in the form of data – prepared before negotiations start. Without data, your practice won’t stand out from others in your area and it will be tough to convince your payer to boost rates, experts say.

Part of a continuing series: This is part of a continuing series on contract negotiations, which will help you prepare for and execute successful contract negotiations with your private payers. You can review all articles in the series via the searchable Part B News archives at www.partbnews.com under the “contract negotiations” search term.

Your best tool to speed the credentialing process with private insurance plans is the CAQH Universal Provider Datasource (UPD), but you must be ready to use paper and push for UPD adoption when dealing with smaller payers.

Use UPD whenever you can: The CAQH UPD service is a widely used online database (http://www.caqh.org/ucd.php) that stores provider credentialing information using a single standard form, one that’s accepted by “almost all the big players,” says Jennifer Searfoss, CEO of Searfoss Consulting Group in Annapolis, Md. “You enter the provider’s information once, and it can be used by all the plans that participate.” In fact, UnitedHealthcare requires all participating providers to credential using UPD, Searfoss says.

These charts examine imaging utilization from 2008 to 2010, with the pie chart showing specialty share of utilization and the bar graph displaying overall imaging utilization across all specialties. NOTE: A total of 10 high-utilization imaging codes from all four modalities were chosen to represent “imaging.” These codes are 71010 and 71020 for X-ray; 70450, 72130, 72193 and 74160 for CT; 70553, 72148 and 73721 for MRI; and, 78815 for PET.

Botox will soon be available for intravesical injection for patients with neurogenic bladder conditions. Do you know the exact date it will be available so that we can start scheduling these Medicare-covered patients for this procedure?

You must take action now to avoid the 1% e-prescribing (e-Rx) payment penalty in 2012 – even if you already submitted a hardship exemption for implementing electronic health records (EHRs), CMS officials tell Part B News. Remember: The deadline to get an application submitted and approved is Nov. 1, otherwise you’ll see the 1% pay hit start Jan. 1, 2012.

You would get an extra $20 per patient, per month for being a primary care practice that participates in a new CMS program called the Comprehensive Primary Care Initiative (CPCI). In return for the cash, your physicians would be required to produce better health outcomes and savings over similar primary care practices that see patients under the traditional fee-for-service (FFS) system. CPCI is a four-year program that pays the extra $20 fee on top of regular Medicare FFS charges.