Every Dollar Counts - Especially In The Physical Therapy Realm

Better #payerrates and #payercontracts can help you combat shrinking reimbursements and thus, keep your lights on, maintain your rental agreements, pay your clinicians and dedicate resources toward helping your community (potential patients).

While not always comfortable, negotiation is an important tool that all providers should have in their toolbelt. We won’t pretend that contract negotiations are easy, but you have to get used to the idea of advocating for yourself.

If you don’t have the tools, resources and expertise, contact us and we will accomplish this for you. Our provider-clients (on average) are seeing a 10% increase in reimbursement across almost all #cptcodes. Results will vary.

Data, Data and More Data

To make the best possible case for the rates you are negotiating (and before you even think about meeting with the payer representatives), you have to know your numbers inside and out.

By comparing the contract allowable(s) for your payers, you can gauge which contracts are the most valuable to your practice. Additionally, you can compare the data for individual CPT? codes and use it to determine which plans pay the least for certain codes, as we do below, using the CodeToolz Contract Analyzer.

Assessing Your Leverage

If you’re a small practice, you might not think you have a lot of negotiating power. And to some degree, that’s true. But that doesn’t mean you should throw up your arms in surrender. If we are negotiating on your behalf, we will never surrender.

In fact, you may have more leverage than you think. Ask yourself;

• Is there a particular niche in which you specialize?
• How many clinicians in your area offer the same types of services that you provide?
• Do you have a strong reputation as a quality rehab therapy treatment provider, especially among top referring physicians?
• What is the density of physical therapy providers relative to your local patient population?

Positioning your clinic as an irreplaceable option for patients in your area, will make payers more willing to negotiate with you to ensure you remain in-network.

Everything Is Negotiable

Providers often think the terms offered in a contract are immutable and the plan representatives may say that they do not negotiate with PT’s. In fact, everything is negotiable.

A basic negotiating principle is to remember that you are negotiating a relationship, not a transaction.

Negotiation is not about being right or wrong, but about finding mutual ground for a win-win solution. For example, help the payer improve the quality of physical therapist services provided to its subscribers in return for fairer reimbursement and achieving direct access to physical therapy care, or help the payer set the boundaries to avoid overutilization of rehabilitation services. The goal is to create an alignment of benefits for both parties.

With all that has been written above, some providers are not (and never will be) comfortable negotiating managed care contracts. If this is you, contact us. Our expert negotiators can call on a range of negotiating styles to use in different situations. Our results prove that.

After The Negotiated Contract Goes Into Effect

Unfortunately, a provider’s work is never done. Providers must closely monitor their business and revenue cycle to ensure that the terms of the new contract have been applied properly and that any changes to those terms are having the expected effect. Essentially, that means you must:

• Verify payment accuracy (and promptly contact the payer to report any inaccuracies).
• Spot trends in inaccurate reimbursements and send those findings (in writing) to the payer’s representative.
• If there’s no response, submit a complaint to the payer’s director, then to the state insurance commissioner and medical society, if necessary.
• Track denied claims by dollar and type; then, compare reimbursement and denial data every quarter in order to accurately gauge each contract’s payment performance.
• Watch for claims that are paid at 100%, because this may indicate that you are actually charging less than the payer’s allowable rate (“Lesser of” contract clause).

Now, you can do this work manually but depending on how frequently and closely you monitor everything noted above, you might not want to. If these activities are taking up too much of your time (and ultimately overburdening your practice), then it might be time to contact us and invest in a top-notch contract management service that monitors these metrics for you, or at least helps you understand the data.

Conclusion

With the CodeToolz Contract Analyzer and negotiating team, PT’s (or any other healthcare providers) have a modern and intuitive end-to-end contracting platform that’s well-suited to their needs, empowering them to be better in business and more importantly, enabling them to provide better patient care. #payerrates #payercontracts #cptcodes

Let the experts at CodeToolz take your contracting efforts from burden to competitive advantage. The bottom line is that in negotiations, knowledge is power and planning is essential. Contact Us Today! (512) 787-1852 or schedule a demo of our CodeToolz Contract Analyzer here.