Focus On Making Your Payers Happy To Improve Reimbursement

By Greg Bengel, contributing writer

Rather than spending all your energies on the physician-patient relationship, one article suggests that putting in more effort with the physician-payer relationship is how providers succeed in getting paid

According to a recent article from Medical Practice Insider, improving provider-payer relationships may make a world of difference for providers when it comes to getting paid or not getting paid.

As is well known, the challenges of revenue cycle management (RCM) pose ongoing and significant struggles to physicians. Getting paid in full and on time is challenging for physicians who are juggling MU incentives, new technologies and legislation.

Health IT Outcomes has touched on the problems before. As previously reported, a Frost & Sullivan report finds that “Many medical practices will need to significantly re-engineer their entire RCM function, and most seek solutions that offer robust integrations between clinical and financial systems." Providers are keenly aware that RCM processes are vitally important, but are struggling to take any steps to make them better. Also previously reported, a Black Book survey reports that approximately two-thirds of the hospitals that predicted in 2012 they would be replacing their core RCM solution in 24 months are not yet even in the planning stages of doing so.

So what are providers to do? According to Medical Practice Insider, “The physician-patient relationship receives a fair amount of attention, particularly with meaningful use Stage 2 and its patient engagement requirements fast approaching. However, payer-provider relations can be just as important to your practice’s viability. Forming fruitful relationships with the companies that reimburse your claims can be the difference between getting paid or not.”

The article offers four pieces of advice for how providers can improve their relationships with payers.

1. “Establish clear, transparent contract rules:” Make sure that the contract is clear and well-defined before signing, the article says. “This reduces the possibility of future disputes, as either party can simply point to the contract when disagreements arise.”
2. “Reduce the administrative burden:” The article recommends practice management software, which helps providers avoid annoying payers by having submitted incorrect claims. Also, “The fewer unnecessary phone calls you make to a payer, the more likely they’ll be responsive when you actually need them,” the article says.
3. “Be courteous on the phone:” This one is a bit of a no-brainer. Don’t put anybody off by being anything less than friendly and considerate on the phone.
4. “Outsource:” According to the article, “Outsourcing your medical billing doesn’t improve payer-provider relations per se, but rather eliminates relations altogether -- which can be a good thing.” Rather than creating a fruitful relationship with the payer, let your billing agency handle things.