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Reimbursement Rates: Don’t Settle for Less

As with anything in the healthcare industry, reimbursement rates are constantly in flux. New providers are often caught between the urgency of signing contracts in order to expand their patient base and the time it takes to negotiate fees(1) that accurately reflect their experience and talent.

Lack of experience can definitely be a liability when it comes to negotiating power. Results are what providers need to prove their value to insurance networks. However, providers can’t get results without being part of a network. Lacking results, a provider’s next best asset is data. Do some homework on your available network options, also taking into consideration providers in both similar and parallel specialties. A strong medical network works just as a strong social network does: it’s who/what you know and who/what they know.

Reimbursement rates are influenced by more than a single physician’s skill. The entire office staff is a reflection of what the physician is worth, including any advance practice providers (APPs), such as PAs and APRNs(3), that support the registered physician. The office’s reputation, clinical quality, professionalism, and patient satisfaction are all measurable components that can help you make an argument for increasing your reimbursement rates every time your contract is up for renegotiation. Keep in mind that insurance companies have their own competition to ward off, and every provider that they can depend on in their provider counts is an asset in their marketing arsenal too.

Our partner, SE Healthcare, has published an insightful piece, titled “Positioning Your Practice to Negotiate the Reimbursement You Deserve from Payers.(2)” This ebook explains strategies to uncover missed opportunities and grow your revenue by maximizing reimbursement rates.

Contact us(4) today so you can take advantage of the benefits of your CARE membership to utilize the expertise of our partner, SE Healthcare. They will help you assess your current reimbursement rates and formulate a strategy to maximize your current reimbursement contracts.

Footnotes

  • https://blog.evisit.com/how-to-negotiate-higher-physician-reimbursement-rates
  • https://www.sehealthcarequalityconsulting.com/download-ebook-positioning-your-practice-to-negotiate-the-reimbursement-you-deserve-from-payers/
  • https://www.physicianspractice.com/article/pas-deserve-direct-reimbursement-their-services
  • https://care-ins.com/contact/

Losing a Provider: Ensure Proper Recordkeeping

Providers change practices every day, so it’s important to have a policy in place to provide guidance for patient care and records retention. A formal policy could include the following elements(1):

  • Notify patients of provider’s departure (state laws vary as to whom the responsible party is for this notification, as do details of what to include in the notice; check with your legal counsel for specifics of your situs state)
  • Instructions for contacting departing physician (if still practicing medicine)
  • Contact information at existing practice for reassignment to another provider
  • Instructions for requesting medical records

Most importantly, the policy needs to be communicated to existing staff so that there is no disruption in continuity of care.

Managing the affected patients is only one aspect of provider departures. When it comes to medical records(2), a policy should specifically outline these elements:

  • Exact end date of departing provider
  • Specific party responsible for transferring and archiving records
  • Which party is responsible for contacting affected patients
  • Updating new provider with relevant medical history of patients

Don’t rely too heavily on electronic recordkeeping, though. Nothing beats the trained eye of a professional. Electronic health record (EHR) systems(3) are only as thorough as the data that a person has entered into the system. Mistakes and oversights are just as likely to happen on a computer screen as they are to happen on paper. While EHRs save time, space, and headaches, they might also be managed with great care upon a provider’s departure from one practice to another. Fastidious record keeping is even more important in the event of retirement or death.

If you would like additional guidance in developing these types of policies for your practice, look to other sources, such as HIPAA guidelines, payer contracts, and federal programs such as the Centers for Medicare & Medicaid Services (CMS) (4).

Contact us today. We can help you formulate these types of policies to ensure that they mitigate your risk from future litigation.

Footnotes

  1. ECRI.org
  2. ama-assn.org
  3. physicianspractice.com
  4. cms.gov

Medical Malpractice Concerns: Mitigating Your Risk

Can physicians and providers take steps to mitigate their malpractice lawsuit risk? While it may seem an inevitability, there are measures you can take to protect yourself and your practice.

The first step involves patient relations. Having a solid rapport with patients before any issues arise is the best way to instill confidence and trust. It is important to communicate to patients whenever a problem occurs. And if that issue includes a physician error, an apology is a necessary component of malpractice mitigation. An honest conversation about what went wrong builds faith in the patient/provider relationship. No one wants to do business with someone that they feel is untrustworthy. Not a mechanic, and certainly not a medical provider. The transparency of communicating the issue is paramount to patient relations, but the solution is also important. Resolve the issue and it strengthens your reputation as a problem solver.

Documentation is an important part of any malpractice avoidance strategy. Documentation is not only about maintaining detailed official patient records about diagnoses and procedures, but also includes proof of all conversations involving consent, care, complications, options, and expectations of both the provider and the patient. An often-overlooked piece of documentation is when a patient is referred to another provider. If their condition is serious, ensure that they understand the urgency in which they need treatment and follow up.

Another element largely at play is simple geography. Educate yourself on your state’s specific malpractice laws. Variations and factors include:

  • Each state’s tort reform laws differ, some require a certificate of merit before a case can proceed through the court system
  • Some states enlist the professional opinion of medical review panels, which are comprised of medical and legal professionals
  • Statutes of limitation also differ between states
  • Damage caps vary, and play a large part in whether attorneys are willing to proceed with malpractice suits

In general, it’s important to have a concrete system of checks and balances in place (this protects both providers and patients). It encourages professionalism at all points of contact and eliminates doubt that any patient is likely to have when undergoing serious/complicated medical treatment. Being deemed reliable is a great way to mitigate your malpractice suit likelihood.

Contact us today. We can analyze your firm’s liability potential and provide you with solutions to lessen your malpractice concerns.