A Recipe For Success

Excerpts from a fun letter one of our clients put together recently. Note the results at the end.

…Vaccine reimbursement is always an issue with your company. In our practice, [MCO] has the lowest vaccine reimbursement of all insurance companies.

The American Academy of Pediatrics has published recommendations for vaccine reimbursement. You can find the document attached to the faxed copy of this communication (see Attachment A). As you can see, the cost to pediatricians of providing the vaccine is 17-28% more than the vaccine purchase price. If the immunization administration is not adequately reimbursed we need to have this cost reimbursed for the vaccine product…

…In the time period of January 1, 2006 to December 1, 2006 [our office] administered a total of two thousand, nine hundred and twenty-six (2,926) immunizations to seven hundred and thirty-four (734) members of [MCO]. Five hundred and forty-nine (549) immunizations were given to members > age eight (see Attachment B) and two thousand, three hundred and seventy-seven (2,377) were administered to members under age eight (8) (see Attachment C)…”

Although these are just some of the highlights, the result is remarkable:

  • >120% of 2007 RBRVS for all codes
  • Major increase for 90465+ ($5 to $22.39, etc.)
  • 120% of Medicare for lab fees

So, how much did this medium-sized practice get from one of its better payors?  They anticipate a $70,000 annual increase.

Who did the negotiation?  Was it an attorney?  A special insurance negotiator?  Their large IPA?  Are they part of a giant practice?  No, no, no, and no.  It was the office manager, using her tools from Partner.  I have another couple tomorrow.

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