4 Ways to Evaluate and Negotiate Reimbursement Specific to Your Practice

When it comes to negotiating reimbursement with your payers, it can feel like a game of whack-a-mole. You know the drill: You send in your bill or claim, and then wait for a response. After months or even years of waiting, you get nothing in return except frustration. Negotiating reimbursement with your payers is a process that requires patience and persistence. To keep things moving and minimize the time between negotiations, you need to streamline the process and use specific tactics to speed up negotiations, such as asking for a negotiation timeline before finalizing any offer.

Understand reimbursement negotiation basics

Before we start talking about specific tactics, let’s take a step back and understand the big picture of reimbursement negotiation. When working with payers, your goal is to negotiate a specific price for your services. Certain factors affect how much you can charge for your services. For example, factors like your practice size, the type of services offered, the geographic location of your patients, and your level of experience or training can all affect your reimbursement rates. Once you’re able to set your price, you have to convince your payer to agree to it, which is no easy task. For most practices, there are several financial barriers that prevent you from signing a written agreement with a payer such as long payment cycles, long-term debts, or an unwillingness to contract.

Streamline processes and create a standard forms/templates

Once you start getting reimbursements, you’ll notice that the process of negotiating with payers is really time-intensive and repetitive. To streamline the process, start creating a standard form/template for all communication with payers. Start with a letter. In this letter, clearly define your business and explain why you’re owed the money. Then, add a few paragraphs about the process for negotiating with the payer. This is important to keep with you throughout the negotiation process. Once you have a template, you can apply it to all your communications with payers. Using a template will reduce the time spent on every single negotiation, saving you precious time and energy that you can use to focus on more important things.  Maximize Your Payer Network – Get In Touch With A Contracting Expert In Your Region

Ask for a timeline to negotiate

In the beginning, it’s important to keep the payer in the know about the status of negotiations. Once you’re in the negotiation process, you have to be proactive. Be aggressive and keep communicating with the payer to keep them in the loop. You can do this by updating the payer on your negotiation timeline. Be transparent, and explain to the payer why you need a certain amount of time to get the deal done. For example, if your payer is seeking a discount as part of the negotiation, be upfront and explain why this discount is important. It could be because the payer has low-income patients that need discounted services, or it could be because the payer has a specific type of insurance that may not cover the full cost of your services.

Ask for help or assistance

In the beginning, you may be inclined to handle every negotiation on your own. This can be a mistake. Different payers have different negotiation techniques, and some practices may even be more aggressive than others. If you’re not sure how to negotiate with a particular payer, you can always turn to your peers in the healthcare industry. For example, if you have a particularly aggressive payer, ask your fellow medical billers where they’ve negotiated with the payer and what they did. You can also consider Shortening the process by partnering with WWS the contracting experts for Ancillary providers nationwide.

Use data to make an argument

There are many different ways you can use data to make your case during a negotiation. For example, you can explain why you have a high number of patients that are uninsured or under-insured. You can explain why your practice is unique and not easily replicated. You can explain the impact of your services on the patient’s health. In each case, you’ll want to make sure that you’re using data to show the full picture of your practice and how your services impact the patient’s health. You want to use data to support your claims for reimbursement, not as an excuse for why you don’t want to negotiate a lower rate.

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• Expertise and experience in the field of DMEPOS of more than 190 years have resulted in us being one of a kind organization. We have discovered simple formulas for handling complex DME activities through this in-depth understanding.
• As part of our holistic approach, we optimize best practices for growth and quality negotiations, tailored to position your organization within a highly competitive and rapidly evolving market. We know what it takes to ensure our providers deliver results.