Physicians Practice - January 2008 - (Page 30)

GETTING PAID YOUR MOST IMPORTANT TO-DO LIST ALLOWABLES FOR NON-E&M CODES CPT CODE 44950 44970 45378 45380 45384 45385 46600 47562 49505 50590 52000 54150 55250 55700 57288 57454 58100 58150 58260 58558 59400 59409 59510 59514 62311 63030 63047 63075 64475 64483 64721 66821 66984 69210 69436 71010 71020 76536 76645 76805 76811 76830 76942 77080 78465 80053 80061 81000 81002 81003 82272 82962 83036 84443 85025 85610 85652 86317 86580 87081 87880 88142 88305 AVERAGE REIMBURSEMENT $838.89 $1,023.68 $395.50 $444.80 $468.00 $442.61 $89.10 $941.64 $688.90 $871.38 $258.78 $185.04 $531.84 $265.33 $1,193.01 $181.49 $124.68 $1,500.21 $1,187.89 $363.33 $1,992.94 $1,244.02 $2,043.59 $904.48 $443.65 $1,221.73 $1,364.68 $2,082.83 $415.81 $386.43 $550.98 $300.49 $758.09 $47.05 $328.77 $42.64 $36.59 $124.71 $91.90 $155.32 $226.97 $111.31 $175.90 $150.60 $796.50 $24.52 $28.30 $4.62 $4.36 $3.20 $4.46 $3.43 $10.22 $39.24 $12.67 $10.05 $8.07 $19.68 $17.41 $8.75 $13.41 $36.64 $100.65 There are a number of proactive tasks you should consider doing to put (and keep) yourself in the best possible bargaining position when it comes to negotiating with payers. Consider these suggestions: Follow up annually. The squeaky doc gets the grease — on your palm, that is. “Squeezing a couple percent out of a payer every year sometimes works better than asking for 10 to 15 percent every ﬁve years,” says Milburn. Alternatively, he suggests, you could agree on a two-year contract with a 2 percent escalation factor. And don’t be afraid to be a pest. “Physicians should insist on receiving a complete fee schedule and coding guidelines from a carrier before signing,” says Breeze. No, the carrier will not want to do this, but be persistent. Read each contract carefully. This can- you 105 percent of their ‘market fee schedule.’ That’s great, but the next year, the market fee schedule can be anything.” What if it’s 10 percent lower than this year? “You just got a haircut you didn’t want on your charges,” she says. Insist on including a clause requiring the insurance company to give you written notiﬁcation of changes. “Not by fax. Not by e-mail. Not by any electronic means,” warns Breeze. “‘Electronic’ means to them that they can tell physicians about a fee schedule change, and it doesn’t have to be in a very obvious place.” If at all possible, engage an attorney to read through the contracts. Yes, this can be pricey, and maybe infeasible for a small operation. But the investment might be well worth skimping elsewhere. Tighten your operations. Consider that a faucet dripping once per second can ﬁll your bathtub 55 times in one year. Yikes. Look around for such “leaks” in your practice. How’s your scheduling? Lots of no-shows? Perhaps an appointment reminder service is in order. Do you use your EMR and practice management software to their fullest capabilities? Try to understand “where not be stressed enough. They are not all the same. Look for red ﬂags such as the aforementioned “evergreen clauses,” meaning automatic renewal, or “market fee schedule” — an insidious reimbursement-sapper. A market fee schedule can be whatever a payer wants it to be, says Breeze. “They may say they’ll pay OUT-OF-POCKET HEALTHCARE EXPENSES FOR CONSUMERS $650 $600 $550 $564 $520 $500 $450 $424 $400 $392 $365 $373 $350 $300 1999 2000 2001 2002 2003 2004 Source: Thomson Healthcare MarketScan database 30 | 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

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