How to Determine Which Insurance Plans to Accept in Your Private Practice?

As a private practice owner, one important aspect of running your business is determining which insurance plans to accept. Which insurance plans you work with are largely based on your goals for your practice and your personal preferences for your workload. There are many factors to consider, including reimbursement rates, network requirements, and administrative burdens. In this blog post, we offer some perspective on these factors and tips on how to use this information to make the right choice for your practice.

Based on where you are located, identify insurance companies that would make sense for you to accept. Create a list of each insurance company in your area and a place for you to take notes on each factor that we discuss. From there, we recommend that you narrow your list down to the top two or three payers that you would like to work with. If you are a new practice just getting started this can help you prioritize which insurance companies to credential with, or if you are an established provider feeling overwhelmed this can help you to slim down your payer list and streamline your business.

Factor 1: Using reimbursement rates to determine which insurance plans to accept

Reimbursement rates, or the rates that insurance companies agree to pay providers for their services, can be difficult but not impossible to find. This is because these rates are considered proprietary information. If you are already contracted with an insurance company, you should have a fee schedule that outlines your reimbursement rates which you can use to inform your decisions. If you are not contracted, you may be able to find information on reimbursement rates by contacting the insurance company, consulting with trusted colleagues, or relying on information from previous practices that you have worked.

Ultimately you will want to compare reimbursement rates for each plan to your practice's overhead costs. Take the average reimbursement rate for a payer multiplied by the number of sessions you expect to complete in a month. Do this for each payer you are considering and compare that to your expected monthly expenses. This will help you determine which plans can provide the most financial benefit for your practice.

While this exercise can help you to choose which insurance companies to work with, these estimates are only as good as your billing practices. Without good billing practices in place, you could experience denials and rejections that result in delayed payment and financial stress. MD Revenue Group offers billing services that take the guesswork out of insurance billing. Your biller has the expertise to make sure that you are maximizing your claim reimbursement, claims are processed cleanly, and any denials and rejections are dealt with in a timely manner to ensure healthy revenue for your practice.

Factor 2: Using network requirements to determine which insurance plans to accept

Another important factor to consider is network requirements, or the stipulations that an insurance company has in place to gate keep their network and reserve space for providers who meet the needs of their subscribers. Some insurance plans have strict network requirements that limit the number of providers allowed into a network. If your practice is not in-network with a particular plan, it may be difficult for your patients to see you, which could ultimately lead to lost revenue.

If an insurance company is at capacity and not accepting providers, you may want to consider another insurance company that is in need of providers. Some insurance companies are in need of providers to serve their subscribers, and you may find that by credentialing with an insurance company that has space in their network may yield more patients seeking your care. You will want to consider your practice goals and the populations that you would like to serve and see if any of the open networks can help you achieve those goals.

If you have current patients with insurance on the closed panel, you can read our article about how to approach getting onto a closed panel, or you can choose to bill those as out of network sessions. Out of network billing has some variance from in network insurance billing, and MD Revenue Group billing services can help providers who would like to go this route.

Factor 3: Using administrative burden to determine which insurance plans to accept

Ask your colleagues (or your biller!) and they will surely have an opinion on which insurance companies they don’t like to work with because they are more difficult than others. Aside from their reputations, which in some cases boils down to a matter of personal preference, insurance companies often have different requirements for submitting claims and maintaining compliance. Keeping track of each process can add to the administrative burden of running your practice. You can mitigate this administrative burden by keeping your payer list small and selective, or you can eliminate it entirely by outsourcing your billing.

MD Revenue Group can help your practice by managing the insurance billing process, including submitting claims, checking for coverage and benefits, handling denials, and following up on unpaid claims. This can help take the administrative burden off of you, so you can focus on providing quality care to your patients. It is especially helpful if you’ve identified an insurance company with reimbursement rates suitable for your practice, relevant to the population you would like to serve, but you are feeling uncertain about the administrative burden required.

MD Revenue Group has experienced team members who are trained and up-to-date with insurance regulations and processes. They provide regular reports to the practice owner, keep you updated with the practice’s billing activities, can recommend changes if any and provide support in case of an audit. Moreover, they will keep the practice updated on the insurance company policies and provide the owner with insights of how it could affect the practice’s revenue.

Conclusion

Choosing which insurance plans to work with is an important and personal choice for your practice. You can use factors such as reimbursement rates, network requirements, and necessary administrative burden to help you choose which insurance payers to work with.