When is the last time you analyzed your practice’s payers?  Too often, physicians and practice managers feel powerless against health plans — and don’t even question whether to continue to accept a particular plan.  Yet, even if your practice is located in a market in which you’ve found it increasingly difficult to negotiate higher reimbursement, that doesn’t mean you must simply accept all other aspects of every payer relationship without question.  Even when reimbursement amounts are similar across payers, differences in payer behavior — what we refer to as ‘hassle factors’ — can actually mean that some payer relationships are unprofitable.

What are some of the hassle factors that add hidden costs and reduce payer profitability?  They include:

  • Consistently slower reimbursement than other plans
  • Repeated requests for referral or authorization
  • Frequent complaints from patients
  • Poor support when help is needed to resolve problems

Are multiple hassle factors a reason to drop a plan on their own?  Not necessarily — if you’re reliant on a plan for a significant share of your revenue, or it reimburses better than others for important codes, putting up with the hassle may be necessary.  (However, in that case, you will also want to do what you can to address some of the ongoing hassles with the payer.)   I shared some further tips on analyzing your payers’ hassle quotients in this article for Kareo — and if you need further help evaluating and segmenting your payers, we hope you’ll get in touch to learn more about our capabilities in this area.

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