2015 User Conference Using Data to Renegotiation Your Payer Contracts April 25, 2015 Presented by: Aimee Heckman OP 15 Billing Manager General Session

2015 Office Practicum User Conference Using Data to Renegotiate Your Payer Contracts ▪ PLAN ▪ Track and monitor your contracts ▪ DO ▪ Value current contracts by assessing fee schedules ▪ STUDY ▪ Analyze current contracts in detail ▪ Identify contract improvements needed from payer ▪ ACT ▪ Renegotiate

2015 Office Practicum User Conference PLAN Monitor your contracts ▪ Keep a master spreadsheet that shows which contracts are due for review ▪ Monitor spreadsheet to determine date for opportunity to improve your contract

2015 Office Practicum User Conference PLAN

2015 Office Practicum User Conference PLAN Set a Timeline to Renewal

2015 Office Practicum User Conference DO Value current contracts ▪Use Office Practicum reports or spreadsheet software such as Excel or Open Office to create a report to compare procedure codes and payments from each payer CPT Code Payer 1:$50 Payer 2:$60 Payer 3:$70 CPT Code Payer 1Payer 2Payer $50$60 $ $55$65 $75

2015 Office Practicum User Conference DO

2015 Office Practicum User Conference DO ▪ Create a second report that compares average dollars deposited per visit from payers ▪ Total the number of visits per insurance company and use that number as the divisor of the total revenue dollars deposited for those visits

2015 Office Practicum User Conference STUDY ▪ What is right about your current contracts? ▪ What do you still need from the insurance company? The greater danger for most of us lies NOT in setting our aim too high and falling short; but in setting our aim too low and achieving our mark. ~Michelangelo

2015 Office Practicum User Conference STUDY Know your current contract and amendments ▪Contracted with Self Funded, Leased Network or Insurance Owned Network ▪Fee Escalators - what % and how often ▪Carve Outs ▪State Laws re: timely payment and timely filing ▪Are you with a Clinically Integrated Network or ACO whose contracts can replace/void your agreement ▪Notice required for contract amendments, term and termination ▪Payment Policies

2015 Office Practicum User Conference STUDY Do you want a quality or value based contract? ▪ What is your leverage? ▪ Size ▪ Low $$ utilization ▪ Clinical Quality ▪Medical Home ▪High Immunization rates ▪Low antibiotic usage ▪Asthma and Obesity

2015 Office Practicum User Conference STUDY Value Based Contracts ▪ Vary by geography ▪ Can be lucrative ▪ Don’t want skin in the game ▪ Local Managed Care hurting on HEDIS? ▪ Peer group can’t manage and lots of referrals and hospitalizations? ▪ New HIN everyone wants you to use?

2015 Office Practicum User Conference ACT Renegotiate ▪ Goal ▪ What you want to achieve in your contract ▪ What result would THRILL you not just satisfy ▪ Bottom Line ▪ What you absolutely MUST agree to ▪ If bottom line is not met, be ready to walk away or have a great poker face!

2015 Office Practicum User Conference Steps to Success ▪Set your bottom line ▪Consider what the payer needs from the practice ▪How the practice meets those needs ▪Be the first to set the contract offer; Have a plan for your counter offers ▪We will do this for the payer and you will do this for us ▪Have your data ready! Fee comparisons - Member Facts - Costs ▪Play smart and confident; Do not appear uninformed or too aggressive ▪Start with the easiest mark, one that you are sure will be met with YES or NO ▪Make counter proposals incrementally, do not go straight to the bottom line ▪Know when to close the deal and push for effective date as soon as possible

2015 Office Practicum User Conference Changes You May Wish to Make ▪ Establish spreadsheets or reporting method to track and monitor your insurance contracts ▪ Consider Value Based Contracts ▪ Maintain Awareness of Payer needs for their members

2015 Office Practicum User Conference

REFERENCES For more information on this subject: Join PPMA and visit the Practice Support page at Insurance Contracts

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