1. 2015 User Conference Using Data to Renegotiation Your Payer Contracts April 25, 2015 Presented by: Aimee Heckman OP 15 Billing Manager General Session

2. 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

3. 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

4. 2015 Office Practicum User Conference PLAN

5. 2015 Office Practicum User Conference PLAN Set a Timeline to Renewal

6. 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 99213 Payer 1:$50 Payer 2:$60 Payer 3:$70 CPT Code Payer 1Payer 2Payer 3 99213 $50$60 $70 99214 $55$65 $75

7. 2015 Office Practicum User Conference DO

8. 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

9. 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

10. 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

11. 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

12. 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?

13. 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!

14. 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

15. 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

16. 2015 Office Practicum User Conference

17. REFERENCES For more information on this subject: Join PPMA and visit the Practice Support page at http://www.aap.org/practicesupport Insurance Contracts http://www.aap.org/en-us/search/Pages/results.aspx?k=Insurance%20contracts

18. 2015 Office Practicum User Conference We want your feedback!