The very first blog I ever wrote was about one client’s fight with an HMO. Now, more than two years later, I continue the battle. Look at this funny message I received today, edited for brevity and privacy:
As promised, the outcome of my recent [HMO] “negotiations.” At the risk of hearing Chip’s “I told you so’s” ring in my ears, the following occurred today: Nearly three months after accepting my termination, and with 5 days to go before the deadline, [HMO]
offered me a greatly improved contract…
The resultant offer improves E&M codes by 40-75% and preventive care by 90-140%, by virtue of and change from a defacto 50% of 2008 rates to 100% of 2009 Medicare…
The vaccines rates are interesting. For many vaccines they pay essentially cost (100% of CDC), for some vaccines, especially the pricier ones, these amounts are enhanced by 5-11%. But… they have set the Vaccine reimbursement rates at 120% of Medicare. Thirty dollars for the first shot helps take the sting out of that a bit. And they paid so little for the nasal admin fees that the new rates are almost a 400% increase.
The after hour codes are still under review. It’s apparent after a few negotiations that is it easier to get a custom fee schedule than to have a policy altered for an individual practice. Perhaps you already knew that!
Lastly the bad news: We took a huge hit on a few procedures. 30-40% Fortunately most if not all of these codes are low volume…
The bottom line. If the current fee schedule had been in effect for 1/1/07 to date, our revenue would have been enhanced by a 31%, which I would project as the enhanced value of the new contract.
31% increase. By asking, dropping, and negotiating. And he’s not done. Anyone else want to tell me it can’t be done?
Meanwhile, I posted a substantial update to our Pediatric RVU Calculator. Check out the new version – flash-based, produces CSVs, etc. Very nice.