Fighting the Empire

A customer called me yesterday to ask, “[Evil Empire HMO] has finally come to the table and is offering me 100% of Medicare on my E&Ms…should I take it?”

Normally, I’d say, “100%?  That’s a joke.”  But this client was calling from a part of the country where pediatric practices average 65-75% of Medicare.  I know of at least three groups (of 5-20 practices each) within 70 miles of of this practice who are trying to merge for the stated purpose of negotiation.  So, here we have a small practice getting one of the worst HMOs to the table on their own.  I figured I’d better check to see what the deal would be worth.

We spent a few minutes in Partner.  If just their 99211s through 99215s are raised to 100% of Medicare, the practice will bring in an extra…$175,000.  Every year.  For for just this one payor.

We quickly agreed to ask for 100% of all codes (you always have to ask), but take 100% for a one-year contract.  And ask for 105% or 110% next year.

Next time you think you need to be big to negotiate, remember this, Example #754.

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