Contracting with payers or networks ensures that services are reimbursed at agreed upon and/or negotiated rates. It may increase the pool of patients available to your practice or simply result in you treating the same patients for less money. The first determination that needs to be made is whether or not contracting with a payer or network is a smart business decision. The network, fee schedules, your costs, your practice demographics are some of the things to consider in payer contracting. Medicare and Medicaid do not negotiate contracts with providers.
However, contracts with other payers can be negotiated yet most providers do not go through this process. They simply accept the payer’s terms leaving money on the table. Billing for non-contracted services means higher out of pocket expenses to the patient and increases denials of claims. These increase the time it takes to work claims along with other related expenses and reduces revenues.
We have used client outcomes data, staffing models, patient satisfaction surveys and clinic features to help clients successfully negotiate higher fees with contracted payers. When contracting initially with a payer, you need to know the net value to your practice of a new patient for each payer type. That requires you to know exactly what your cost to treat a patient is. Then you need a market assessment of how the contract will impact your volumes and profitability. Contact us to see if CRS can help with your contracting needs.
Certified Reimbursement Specialists has been a great asset to Peak Performance Physical Therapy’s overall mission. Certified...
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