Insuring Against Insurance



We all know the drudgery of dealing with insurance companies. It seems like they know every trick in the book to avoid reimbursing our physicians properly, and that's partly because they have a monopoly on the market.




Recently, I jotted down an outline of some ways to keep on top of the situation, and I thought I'd share them with you now:

• Costs - The cost of running a medical practice is varied and complicated. There's overhead, personnel, rent and supplies, just to name a few components. Some of our doctors think you can make up the difference through volume, but that's a losing strategy. Even if you are just in the ballpark, knowing the overall cost of operating your office will give you a stronger bargaining position.



• Your payer reps - They are the face of the insurance company and usually they get the brunt of the abuse. Become familiar with the person who does the job, and try to avoid confronting them. Remember that facts and data are a more powerful argument than emotion, regardless of how legitimate those feelings may be.



• Contracts - Always--always--keep a clean storage space devoted to contracts. This should be a constant, regardless of staff turnover. Also have off-site backups and maintain all versions; you never know when someone is going to argue a fine point.



• Renewal dates - Use your computer software to warn you about any upcoming renewal dates for contracts. Pay special attention to evergreen clauses. Sometimes I think insurance companies count on physicians missing these imporant deadlines.



• Obtain information - Before you sign with a carrier, get a complete fee schedule and coding guideline. Also read your contract carefully, and if possible have an attorney offer their opinion as well. Insist on written notification for any changes in the contract.



• Coding - Make sure to have a staff member who is coding-certified, and up-to-date on all of the current codes. Accurate information will allow you to obtain the maximum reimbursement for a given service.

Even though I will admit to some animosity toward insurance companies, I realize the folks who work for them are generally good people just trying to do their job. It's a shame we can't work more in concert for the sake of the patients, but I insist that all of our dealings with them remain on a professional level.

If you have any tips or suggestions on how you deal with them, by all means leave a comment. I enjoy hearing from you.