3 tactics to take control of payer reimbursement

As demonstrated by the more than 4,700 recent physician remarks about their relations with payers, physicians believe that insurers strive to wear them down with repeated denials and paperwork demands in hopes that a high percentage of doctors will give up trying to secure their deserved reimbursement, Medscape Medical News reports. "Feelings of outrage, resignation, and powerlessness dominated the comments" that the editors of Medscape's "Insurer Ratings Report 2011" recieved.

But despite the many aspects of reimbursement that are out of physicians' control, the article pointed out three concrete ways physicians can (and should) take ownership of their practice revenue cycle:

  • Create a culture of awareness. "The percentage of physicians who say that they don't know what they're billing or receiving for their largest CPT code is overwhelming," Judy Aburmishan, a partner in FGMK LLC in Chicago, told Medscape. Even if they are employed, doctors should recognize that proper reimbursement can affect their compensation. Therefore, consultants advise physicians to review their claims and contracts at least quarterly to see if insurers are reimbursing at agreed-upon rates.
  • Whittle your list of payers. While many physicians contract with as many as 20 payers, experts say a better strategy is to drop the lowest-volume or paying insurers, even if that means some patients will have to file their own claims. However, physicians should also take care of the patient base and the major employers (and the plans they provide) in the region into consideration before making decisions.
  • Fight denials. Although the overall accuracy of claims appears to be improving, according to the American Medical Association, don't ignore unjustified denials. According to one survey respondent, the best way to get a plan's attention is to "let the plan know that you'll notify your state insurance department about unjust denials."

To learn more:
- read the article from Medscape Medical News