RESPONSES FOR NEGOTIATING FEE SCHEDULES
Jessica Longoria
Description
Collection
Title:
RESPONSES FOR NEGOTIATING FEE SCHEDULES
Creator:
Jessica Longoria
Date:
8/4/2014
Text:
I had MANY people request answers for my previous post on negociating
tips/advice for fee schedules. See below:
I have to bleed with you on this one. Our profession due to the small
population we treat, and our small numbers of professionals is unseen. Its
not going to get better. I will look to the future when physical
therapists and occupational not only fit our devices, but some how fold us
into their profession; but that my response will not address that issue.
Jessica, if the insurance company will meet with you that is one way to
inform them. The other side of the coin is to decide if you want them or
need them. I was told two decades ago that 80% of your referred work is
from 20% of your referral sources. That may or may not still be true.
Before you chase them see how valuable they are; and if they are looking
for a dirt cheap price that tells you right there to stop chasing them. I
don't know you area, or who the insurance company is so you have to decide.
Maybe they need information, maybe not. In short see if its worth your
time upfront.
Perhaps someone on the list has source that publicly rates the performance
record of an insurance company's reputation in how they secure quality
prosthetic / orthotic services for their clients. Perhaps check with the
Amputee Coalition organization, 888-267-5669.
The true value of O&P technological intervention is being entirely
overlooked by third party payers. That being the case, you can perpetuate
this oversight by simply attaching a sales price to and with manufacturing
costs if you so choose.
Wow Jessica, you asked the million dollar question. I work in Tennessee
and BCBS saw fit to cut everyone to 75% of Medicare. I am part of a
coalition to change that. We are scheduling a meeting with their
executives to discuss the matter. One tactic I know has worked with
United, because they pay the worst, is to change the numbers on the
contract, sign it and send it back to them. When they refuse it and send
another contract to sign, just do the same thing. Otherwise, just tell
them no, because accepting substandard pay hurts the entire profession. If
you can sit down with them and talk, then email me and I can give you some
tips for the meeting. Also, please click the link below to sign our
petition and share it with everyone you know. They do not have to be in
Tennessee and it can literally be anyone. Thanks and best of luck.
Counter offer and explain why
We have been successful on two new recent contracts finding the local
network contracting person and presenting to them why we should be paid
better than the terrible rates that they were offering.
We show them our evaluations, dictations, video and photographs that we take
of each patient. Then we show before and after of the patient with a great
functional outcome, and provide evidence of the quality and fit of our
devices.
At the very end we show them our company video and talk about our
philosophies.
If they are willing to negotiate pull hard on the heart strings, if they do
have a heart, it works.
You have to hold strong and educate them. Be sure they fully understand
the scope of service - get the spread sheet from AOPA that shows the
historical CPI index compared to rate increases for O&P - and in the end -
decline the contract if you have to. If providers continue to take
unreasonable rates then you just shoot yourself and everyone else in the
foot going forward. We had a similar incident here in MA - more than half
the providers in the area declined the contract (and it was one of our
bigger ones) because the rates were ridiculous - we would have been
providing service for less than what it cost us to purchase things...we are
still in business 3 years later and the bottom line hasn't suffered. I
don't know how those other companies have offset it but one can only assume
it encourages up-coding and unnecessary add-ons we also educate the
insurers of that fact as well that they will encourage inferior products,
inferior service for their members or risk abusive billing. Educate the
referral sources -give them a blind spread sheet showing how they compare
and work to get them to reimburse appropriately. We worked with BCBS in Ma
and told them what codes had rates that were too high - told them where to
cut rates and where they had to preserve or increase rates...we educated
them on custom fab, custom fit versus off the shelf - and it worked. You
need to protect yourself and the industry - taking bad contracts doesn't
help anyone in the long run.
Oh, the golden question! And a good one.
Insurance companies have their own maximum allowable. Anything they
negotiate UNDER that allowable is increased profit. If their max is say 5%
less Medicare and you agree to 8% less, they profit more. The key is in the
process of counteroffers and finding a balance for the counteroffer that
will keep the negotiations open. You must also consider the types of
patients this insurance will provide you and what that's worth to you. A
Medicaid contract is more negotiable than a no-name that will yield only a
few patients yearly. You can still deal with no-name insurances on an
individual basis and can generally get higher rates doing it that way versus
entering into a contact. I usually counteroffer with a % ABOVE Medicare
(2-3%) and see where the negotiations lead. Most of my contracts are within
10% less Medicare. I have found it more profitable to NOT contract and then
pick & choose what orders I want. If it's something that won't be
profitable, you can choose not to do it if you're not contracted.
--
*Jessica Falknor Longoria*
*Centers for Mobility/A Touch of Pink*
*7777 Southwest Freeway 107*
*Houston, TX 77074*
*713-773-0969*
*www.CentersForMobility.com < <URL Redacted>>*
tips/advice for fee schedules. See below:
I have to bleed with you on this one. Our profession due to the small
population we treat, and our small numbers of professionals is unseen. Its
not going to get better. I will look to the future when physical
therapists and occupational not only fit our devices, but some how fold us
into their profession; but that my response will not address that issue.
Jessica, if the insurance company will meet with you that is one way to
inform them. The other side of the coin is to decide if you want them or
need them. I was told two decades ago that 80% of your referred work is
from 20% of your referral sources. That may or may not still be true.
Before you chase them see how valuable they are; and if they are looking
for a dirt cheap price that tells you right there to stop chasing them. I
don't know you area, or who the insurance company is so you have to decide.
Maybe they need information, maybe not. In short see if its worth your
time upfront.
Perhaps someone on the list has source that publicly rates the performance
record of an insurance company's reputation in how they secure quality
prosthetic / orthotic services for their clients. Perhaps check with the
Amputee Coalition organization, 888-267-5669.
The true value of O&P technological intervention is being entirely
overlooked by third party payers. That being the case, you can perpetuate
this oversight by simply attaching a sales price to and with manufacturing
costs if you so choose.
Wow Jessica, you asked the million dollar question. I work in Tennessee
and BCBS saw fit to cut everyone to 75% of Medicare. I am part of a
coalition to change that. We are scheduling a meeting with their
executives to discuss the matter. One tactic I know has worked with
United, because they pay the worst, is to change the numbers on the
contract, sign it and send it back to them. When they refuse it and send
another contract to sign, just do the same thing. Otherwise, just tell
them no, because accepting substandard pay hurts the entire profession. If
you can sit down with them and talk, then email me and I can give you some
tips for the meeting. Also, please click the link below to sign our
petition and share it with everyone you know. They do not have to be in
Tennessee and it can literally be anyone. Thanks and best of luck.
Counter offer and explain why
We have been successful on two new recent contracts finding the local
network contracting person and presenting to them why we should be paid
better than the terrible rates that they were offering.
We show them our evaluations, dictations, video and photographs that we take
of each patient. Then we show before and after of the patient with a great
functional outcome, and provide evidence of the quality and fit of our
devices.
At the very end we show them our company video and talk about our
philosophies.
If they are willing to negotiate pull hard on the heart strings, if they do
have a heart, it works.
You have to hold strong and educate them. Be sure they fully understand
the scope of service - get the spread sheet from AOPA that shows the
historical CPI index compared to rate increases for O&P - and in the end -
decline the contract if you have to. If providers continue to take
unreasonable rates then you just shoot yourself and everyone else in the
foot going forward. We had a similar incident here in MA - more than half
the providers in the area declined the contract (and it was one of our
bigger ones) because the rates were ridiculous - we would have been
providing service for less than what it cost us to purchase things...we are
still in business 3 years later and the bottom line hasn't suffered. I
don't know how those other companies have offset it but one can only assume
it encourages up-coding and unnecessary add-ons we also educate the
insurers of that fact as well that they will encourage inferior products,
inferior service for their members or risk abusive billing. Educate the
referral sources -give them a blind spread sheet showing how they compare
and work to get them to reimburse appropriately. We worked with BCBS in Ma
and told them what codes had rates that were too high - told them where to
cut rates and where they had to preserve or increase rates...we educated
them on custom fab, custom fit versus off the shelf - and it worked. You
need to protect yourself and the industry - taking bad contracts doesn't
help anyone in the long run.
Oh, the golden question! And a good one.
Insurance companies have their own maximum allowable. Anything they
negotiate UNDER that allowable is increased profit. If their max is say 5%
less Medicare and you agree to 8% less, they profit more. The key is in the
process of counteroffers and finding a balance for the counteroffer that
will keep the negotiations open. You must also consider the types of
patients this insurance will provide you and what that's worth to you. A
Medicaid contract is more negotiable than a no-name that will yield only a
few patients yearly. You can still deal with no-name insurances on an
individual basis and can generally get higher rates doing it that way versus
entering into a contact. I usually counteroffer with a % ABOVE Medicare
(2-3%) and see where the negotiations lead. Most of my contracts are within
10% less Medicare. I have found it more profitable to NOT contract and then
pick & choose what orders I want. If it's something that won't be
profitable, you can choose not to do it if you're not contracted.
--
*Jessica Falknor Longoria*
*Centers for Mobility/A Touch of Pink*
*7777 Southwest Freeway 107*
*Houston, TX 77074*
*713-773-0969*
*www.CentersForMobility.com < <URL Redacted>>*
Citation
Jessica Longoria, “RESPONSES FOR NEGOTIATING FEE SCHEDULES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/236682.
