Payer Contracting Workshop - March 20, 2013

Payer Contracting Workshop - March 20, 2013

The Greater Louisville Medical Societyhosted two payer contracting workshops on March 20, 2013. Josh Kaufmann and Dan Hounchell of Praesentia LLC, a consulting group out of Cincinnati, OH, shared effective tools and trade secrets to assist practices in managed care negotiations. The first session wasjointly sponsored by the Louisville Chapter KMGMA. The evening session was held at the home office of the Greater Louisville Medical Society, in the old medical school building.

Addressing the biggest payers - Anthem’s and Humana’s reimbursement rates are a vital piece of your revenue. The keys to getting their attention:

• Forget the past – there are no retro-active increases.
  
• Show that you save money or that you COULD – if reimbursed higher, you could do x,y,z. Use date to prove better outcomes or low admission or post-op rates.
  
• Take meticulous notes – document every communication
  
• Be persistent – wear them down. Their first answer will be no. Keep asking.

Small payers – same ideas apply except you may have more leverage with smaller payers. They respond better to threats of bad publicity or de-contracting.

Effective tips:

• When not getting a response from your requests for communication, send them a log of your attempts at communicating with them – show them you are keeping track of their lack of reply/follow-up
  
• The payer may request that you prove that they are paying below all other payers – send them the blinded data – they already have the data but show them that you have it too
  
• Collect 10-20 letters from patients. Hand written, not dated, addressed to the practice. Scan letters and save as separate pdf files. If things are not going well in the negotiations or you hit a stalemate, send them a couple of patient letters - shows that your practice is organized and your patients are behind you
  
• Benchmark your practice. Know where you standand where you need an increase.
  

The GLMS Physician Education and Practice Support Department has additional resources to assist with your contracting needs. Stephanie Woods, GLMS Senior Advocacy Specialist, would like to visit with your practice for an Advocacy House Call to discuss these resources further and other ways that GLMS can support your practice. If you are interested in an advocacy house call, contact Stephanie at 736-6350 or .