HFMA - Managed Care Road Show - February 26th

The HFMA Managed Care Roadshow was worth more than the time and money paid to attend. There were three excellent speakers who shared some practice tips and resources for bolstering the income and collection rates for providers. I'll share a few words of the wise with you now, but you'll have to attend the spring roadshow at El Camino Medical Center for the rest.

1. Evaluate your contracts Many commercial payers are paying physicians as little as 75% of Medicare rates and some end up with even less when their collection rate is factored in. It pays to know your market value. Some of the biggest payers only negotiate with those that have market leverage. However, when you get your shot at the table be ready to back up your claims of better outcomes, timely service or experience with data to demonstrate why your practice is the "best". Third party payers are only required to provide their members with "competent" physicians not the best. Sad but true.

2. Appeal claims the right way One size does not fit all. You have to know exactly why a claim is rejected to appeal and get paid. Sounds easy enough but getting the answers is sometimes easier said than done. Managers should review the appeals to ensure each one addresses the right issue and that the argument for payment is sound. After all, you only get three shots to get it right. You can't afford to waste one. According to Sheri Byrne-Haber, MBA, JD your appeals should include:

1. Address/Patient info block
2. What is this letter about?
3. Why are you right and the insurer wrong?
4. Patient history
5. Appeal history
6. Appeal arguments
7. Conclusion

Lastly, don't send a copy of the entire chart. Send the parts of the chart that are needed to support your argument unless the entire chart has been requested.

Check back in a few weeks for the dates and details of the next event.