Managed Care Contract Negotiations, Medical Practice Management
Jun 18

Physician reimbursement analysis

Have you checked your managed care reimbursement lately? If not, you may be losing revenues!!

Please do the following:

  1. Prepare a spreadsheet for your top 8 managed care payers. On this spreadsheet, write down for each payer the current allowables for your top 20 CPT codes. Be sure to take these allowables off of most recent EOBs.
  2. Next, add a column listing the current Medicare allowable for each of the 20 CPT codes.
  3. For each CPT code, then record what percentage of current Medicare rates you are getting reimbursed (You might be surprised here).
  4. Finally, compare the allowables to the managed care contracts for each of the 8 payers. Is this the reimbursement rate you are suppose to be getting?

If reimbursement is low or unacceptable, RENEGOTIATE your contract! If reimbursement is incorrect, submit a sample of EOBs to the payer so they can investigate the reimbursement – You may be due some refunds.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →