How to Negotiate Fee Increases with Insurance Companies

Physicians are often unaware they can consider negotiating reimbursement rates with insurance companies. After all, health care providers and their networks play an important role in the insurance business. There may be times reviewing your existing contract helps, such as when there are changes or updates to CPT, diagnostic, and behavioral health billing codes.

In doing so, you could find opportunities to renegotiate a contract with an insurance provider. Depending on the practice, the reimbursement rates may differ, even for similar types of treatments and services. This can result in being reimbursed less than other practices, which negotiated their original contract differently. A thorough review can also reveal outdated codes that are no longer accepted and which should be updated.

If you’re not satisfied with your insurance provider’s reimbursement fees, these tips for negotiating rates with insurance companies can help:

Understand Your Role in the Network

The more you understand how your practice fits in, the more negotiating power you may have. You’ll also need to prove you’re an asset to the network. Cost savings is one way you can stand out. Be prepared to bring numbers and figures to the negotiating table. Desirable factors include providing specialties scarce in your area, having favorable clinical outcomes, and employing a nurse practitioner who provides less acute care at lower rates.

Gather Your Data

To negotiate a better reimbursement rate, first you need data to back up your reasoning. First, list your most common CPT codes and their frequency; this reveals how often you provide a particular service over a specified period of time. Billing software can generate reports automatically to avoid time-consuming manual processes.

Next, identify your top payers, reimbursement for each code, and fees for each one. Then organize all the data into a chart or spreadsheet for analysis. Codes with higher volumes and dollar values will yield the most return, so focus your efforts here first. Another negotiating point can target health plans with lower rates or codes that are paid at a much lower percentage of Medicare than others.

Negotiate Individual Fees

Your data analyses can reveal individual services you can try to negotiate fees for. Payers generally don’t grant fee increases across the board, but you can deliver your argument targeting specific services to the health plan’s provider relations representative, who can forward it to a network manager or contracting manager. For a new procedure or one that’s not well-defined, a medical director can support a payment increase request for its respective code (although they’re typically not responsible for negotiating rates).

Whenever any contract changes or proposals are made, read the plan and its addendums or attachments carefully before signing it. The changes shouldn’t, for example, conflict with malpractice coverage. If anything is unclear, have a legal consultant review the contract.

Psychiatric Billing Associates can help if you need assistance with claims processing, collections, patient billing, or financial reporting for your mental health practice. To learn more about how we can help, call us at 800-650-6334 extension 947 today.