Look at your patients to ID potential contracts
Identifying the best payers with whom to contract in your area can be done by researching local employers, but another way is to pay attention to what insurance cards you see from your patients.
"When we start seeing more patients coming to us with an insurance company for which we are an out-of-network provider, we contact the company about negotiating a contract," says Brien Fausone, MA, MBA, administrator of the Michigan Endoscopy Center in Farmington Hills.
Some patients might have just started as new patients for the physicians practicing at the center, while others may be longtime patients who have changed insurance carriers, he says. A new physician to the practice or a physician's new relationship with a local employer or a primary care physician also might create a stream of patients with noncontract insurance payers, Fausone says.
Will you get reasonable rates?
Not all overtures to local insurance plans pay off, he points out. Some plans don't offer reasonable rates when approached, Fausone adds.
If a physician has a relationship with the payer or has patients covered by the payer, Fausone notifies the physician of the unsuccessful effort to contract with the payer. "We suggest that the physician perform procedures for this patient at the hospital," he adds.
Another option, sources say, is that the physician group could put pressure on the payer for better rates or for a combined rate for the facility, anesthesia, and the surgeon.
Identifying the best payers with whom to contract in your area can be done by researching local employers, but another way is to pay attention to what insurance cards you see from your patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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