Payers

Certainly physicians are not all-knowing and there are times when the needs of the patient does not correlate with the assumptions of the third party payers, namely the insurance companies.

Our latest analysis of the annual ranking of payers based on hassle factor is here. The good news: Most insurers are paying faster, denying less, and making their processes more transparent. But there's still room for improvement.

Changes with ICD-9 and CPT codes have been commonplace for several years and will almost assuredly continue, even with the adoption of ICD-10 in 2013. We must adapt to the change by updating our practice management systems to include the changes to ICD-9, CPT, and new rules by CMS and insurance payers.

Once you know your practice is being evaluated by payers, monitor yourself using the same metrics to stay on top of your game.

The latest study results from the AMA when it comes to payers and their power in local markets may not be good news to all.

More and more patients are using complementary and alternative methodologies to supplement their healthcare, so it's time for docs to learn more about this growing field. Here's what you need to know about CAM and the role it can play in your practice and patient care.

As many third-party payers tighten their belts even further with restraints for prescription drug coverage, radiology services, specialty referrals, etc., we physicians are left at the end of the day spending even more time with filling out more forms, seeing less patients, and seeing our total costs increase even more as our overall efficiency decreases.

Why spend hours on the phone with payers when you can check online in minutes?

The toughest payers to collect from are your own patients. Don't despair, there are things you can do to get paid.

Our 2010 Fee Schedule Survey indicates that with commercial payments narrowly keeping pace with Medicare, practices need to get paid more for the work already being done.

Can you still use the consult code for Medicare and private payers?

What can you do if your payer won't reimburse your practice for cleanly submitted claims?

Negotiating rates with your payers is important, but so is the language in your contracts. Practices can face a number of possibly adverse provisions that could contradict practice policies and cause confusion with patients. But how do you discover and address such provisions?

Daniel Block, MD, describes his best day as a physician, a day when he took on his patient's insurance company to get the patient the prescription drug he needed.

Do you make the grade? Expert Susanne Madden explains what physician profiling is, how it can affect your bottom line, and what you can do about it.

Some payers are now requiring that non-radiologists get certified or accredited to perform ultrasounds. Otherwise, guess what - they won’t pay.

If you can't verify a patient's insurance, their signature on this form shows they know they are responsible for payment.

Medicare denies claims for 26 percent of all services submitted. More distressing -- 40 percent of those services are never resubmitted for payment by providers. Talk about missed opportunities! Customize this form letter -- and the ones below -- to appeal claims denied, no matter who the payer is. Use this letter to show payers that the claims you are sending are not dups, but corrections.

Manage your denials from insurance companies by tracking them in this worksheet. Track the denials according to the functional area to identify opportunities for improvement. By tracking and monitoring denials, you can fix the problem and prevent denials in the first place.

This simple work sheet will let you compare your payers' reimbursement for specific procedure with your costs for each procedure. If you're spending more to provide a service than you're making for it, then it's time to address the problem.

Use this easy calculator to find out which of your payers are worth your efforts. By comparing the percentage of revenue to the percentage of patient encounters for each of your payers, you can tell at a glance which plans are the poor performers.

This is the first in a series of letters to use for patient collections.

Physician profiling is used by payers to steer their members to in-network physicians who, by their measures, are the most cost-efficient and provide the highest quality of care. Wonder if you’ve made the grade? Look yourself up in a provider directory: if you see a star or two beside your name, you’ve been profiled.

In the current economic environment, physicians across the country may soon be facing pressure - not only from Medicare, but also from commercial payers - to lower their incomes substantially.

Our fifth edition of PayerView uses real claims data to examine and rank payers based on financial and administrative performance, as well as efficiency. Here’s to friendly competition that helps docs get paid.