For many of us, a New Year means creating resolutions or to-do lists. If you run a medical practice one of the things on your to do list should be to take a look at and analyze your current reimbursement rates. If you can gather enough information, you may be able to negotiate better rates.

Sadly, approaching a payer asking “Please may we have an increase?” is unlikely to be successful, even if you say please.  Instead, you need to take a reasoned approach, providing specific data and give the payer a reason to increase your rates.

Here are a few steps you can take to increase your chances of a successful rate increase negotiation:

  1. In order to negotiate better reimbursement rates you need hard data to prove your case. Go over the last six months to one year of your billing history to determine what codes your organization bills the most. Once you compile that data, decide what you want the reimbursement for those codes to be. It is best to focus on specific CPT codes, as payers are most likely to allow for increases to specific codes than an overall rate increase to the entire contract.
  2. Organize this data in a fee analyzer or spread sheet. You want to have information that you can easily present to payers.
  3. Be prepared to explain to payers why your organization is an asset to the network and to demonstrate your value over other provider organizations. You want to be able to give them a reason to up your reimbursement. The high quality of your services, accessibility for new patients, meeting geographic or specialty need are some assets you can focus on.
  4. Once you have your easy to read spreadsheet and a list of reasons why your organization is valuable to the network, reach out to your payer representatives and make your case, beginning with the payers with the most volume.

Remember, even a slight increase to the reimbursement of a frequently billed code can result in a significant increase to your bottom line.  If you are unsure as to how to begin this process, one of our experts at Managed Care Partners can help.