Physicians Practice - January 2008 - (Page 24)

GETTING PAID THE UNGILDED LILY WHAT YOU’RE UP AGAINST First, the numbers: Average reimbursement for E&M allowables dropped to $73.48 — a 6.5 percent drop since 2006. Shocking? “Not really,” says Susanne Madden, founder of the Verden Group, a managed-care consulting company. “But it’s discouraging to see how much rates have moved down again.” The biggest single-year step down was in the Mountain region, where the average E&M visit allowable fell 12.5 percent to $83. But worse than this is the Paciﬁc region, which slipped more than 20 percent in 2006 and lost another 9 percent last year. Two data slices are particularly disheartening: City docs will be unhappy to see that reimbursements in urban areas, which have historically outranked suburban and rural areas, fell to the lowest of all three area types for the ﬁrst time. And no matter where you practice, the reimbursement gap hits primary care the hardest, when compared to medical and surgical specialists. One bright spot: New England, whose average reimbursement had tumbled 27 percent in just 12 months during 2006, reclaimed nearly 11 percent of that deﬁcit, and now stands at the above-average $84. PAYER REIMBURSEMENT: A DOWNWARD TREND Average, All E&M Codes, 2004 – 2007 It’s hardly surprising that physicians are feeling like 98-pound weaklings up against a sand-kicking bully at the beach these days. Health insurance is now all about survival-of-thebiggest, meaning in many cases a handful of companies hoarding the bulk of the market. Why should payers worry about so-called “fair” negotiation? Is there even such a thing? Just four insurance companies — UnitedHealth Group, WellPoint, Aetna, and Healthcare Service Corporation — occupy more than a third of the market (36.5%). Greg Mertz, president The Horizon Group, a healthcare consulting ﬁrm, says that the insurance behemoths don’t sit down at the table with anybody because they don’t need to. “They just can’t ﬁnd the time to meet with you,” he says. “You ask for a meeting weeks in advance: Nope, not available.” As physicians, of course, you know you cannot commiserate on your fees; but insurance companies can in fact collude with each other. “I never talked to a rep that didn’t know what his competitors were paying,” says Mertz. And yes, you’re trying to make a living, but your ﬁrst priority is to your patients. Compare this with an insurance company, which must answer to IN SUMMARY Results from the 2007 Fee Schedule Survey are disturbingly similar to 2006: another sizeable drop in E&M visit reimbursement. Even more payer consolidation. And payers who stonewall on contract negotiation as a matter of policy. Speciﬁcally: However, physicians can improve their leverage by trying these solutions: • Know your practice’s ﬁnancial data, • Average reimbursement for E&M allowables dropped to $73.48 — a 6.5 percent drop since 2006. your costs, who your payer reps are, where your contracts are located, all of your contract renegotiation dates, how much money you want and why, and how to drop a carrier. • Follow up with your payers annually, and read each contract carefully, with an attorney’s help, if financially feasible. • The Mountain region average E&M visit allowable fell 12.5 percent to $83, while, even worse, the Paciﬁc region, lost another 9 percent last year after slipping more than 20 percent in 2006. • Code and bill properly, and make sure the person(s) responsible for this are coding-certiﬁed. $110 Average Reimbursement for All E&M Codes $100 $102.69 • Reimbursements in urban areas, which have historically outranked suburban and rural areas, fell to the lowest of all three area types for the ﬁrst time. • Primary care was hit the hardest, when compared to medical and surgical specialists. $78.18 • Ramp up your patient collections by getting copays from patients while they’re still in your ofﬁce, preverifying insurance coverage, and helping patients to manage their out-ofpocket costs better with automatic debit card payment plans, healthcare-speciﬁc “credit cards,” or online payment portals. $90 $87.86 $80 $73.48 • Advocate for yourself by writing letters to any political ﬁgure that makes sense, at all levels of government. • One bright spot: New England, whose average reimbursement had tumbled 27 percent in just 12 months during 2006, reclaimed nearly 11 percent of that deﬁcit, and now stands at the above-average $84. $70 • Tighten up your practice operations by making sure your processes are streamlined and your stafﬁng is optimal. $60 2004 2005 2006 2007 24 | PHYSICIANS PRACTICE | JANUARY 2008 WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - January 2008

Physicians Practice - January 2008 Contents The Bigger Picture: Fixing Medicaid Letters Physicians Practice Pearls: You Can Teach an Old Dog New Tricks Noteworthy Cover Story: Fee Schedule Survey: 2007 Results Adding Ancillaries: Bucking the Practice Ask the Experts Idealab: 'How I Got Over My EMR Excuses' Technology: Don't Be Denied The Tech Doctor: Blessing or Curse? The Administrator's Desk: Learning From the Best Coding Career: To Partner, or Not? Management: Controlling Your Inventory Human Resources: How to Fire an Enployee Finance: Beyond Reimbursment - How to Fix Your Mix Classifieds Advertiser Index

Physicians Practice - January 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.