…where fame and fortune await those who help keep pediatric practices alive and independent!

Insurance Negotiation Continues

April 17, 2009 / 0 Comments / in insurance, rvu / by Chip Hart

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.

Tags: insurance, rvu

0 replies


PCC Pediatric EHR Solutions

Recent Posts