Craig Antell, DO, a physical medicine and rehabilitation physician at Madison Avenue Physical Rehabilitation and Wellness in New York, which includes a sports medicine practice, discusses four ways sports medicine practices can negotiate more successful contracts with payors.
1. Achieve certification in sports medicine. Demonstrating to payors that your practice's physicians are certified in sports medicine gives you more negotiating power when finalizing details in payor contracts. Dr. Antell says you can use this as leverage to show payors you are more qualified than other physicians who just say they practice sports medicine.
2. Partner with a larger entity. Dr. Antell says larger sports medicine practices will have greater negotiating power and leverage. PRW has a staff of 16 full-time therapists and five physicians, as well as one pain management physician, but the practice is also part of a larger entity that negotiates contracts for all its members. Dr. Antell also is part of an association through NYU Medical Center, which negotiates payor contracts on a bulk basis, thus achieving more favorable compensation rates. Most major hospitals have such an organization, and joining one is a great way to achieve higher reimbursement, Dr. Antell says. These organizations are very selective in who may participate and thus are able to give the carriers quality physicians in their network.
3. Fight for the big ticket items. Dr. Antell says it is critical for a sports medicine practice to know where to focus on fighting for the better reimbursement. This starts with analyzing where your practice makes the most money and working with insurance companies to get greater coverage in those areas because sports medicine practices won't be able to win every battle at the negotiating table.
"You can pick and choose your fights, but I'd rather fight for the bigger ticket items instead of the smaller ones like office visits," Dr. Antell says. "For example, sports medicine practices could be negotiating epidural fees for $750 instead of $500 but fall into the trap of trying to increase reimbursement for office visits from $85 to $100."
4. Hire a consultant. Another strategy sports medicine practices should consider is hiring a consultant who can negotiate better payor contracts as a "middle man." Dr. Antell says his practice works with a consultant for insurance companies not already in a contractual relationship with NYU's UPN. Consultants are often associates who formerly worked in the health insurance industry, so they are keenly aware of how to successfully negotiate better contracts, he says.
"Typically, consultants cost anywhere between $5,000-$10,000, which sounds like a big investment up front, but it's really not when you take a step back and look at increased reimbursements throughout the year," Dr. Antell says.
Learn more about Madison Avenue Physical Rehabilitation and Wellness.
1. Achieve certification in sports medicine. Demonstrating to payors that your practice's physicians are certified in sports medicine gives you more negotiating power when finalizing details in payor contracts. Dr. Antell says you can use this as leverage to show payors you are more qualified than other physicians who just say they practice sports medicine.
2. Partner with a larger entity. Dr. Antell says larger sports medicine practices will have greater negotiating power and leverage. PRW has a staff of 16 full-time therapists and five physicians, as well as one pain management physician, but the practice is also part of a larger entity that negotiates contracts for all its members. Dr. Antell also is part of an association through NYU Medical Center, which negotiates payor contracts on a bulk basis, thus achieving more favorable compensation rates. Most major hospitals have such an organization, and joining one is a great way to achieve higher reimbursement, Dr. Antell says. These organizations are very selective in who may participate and thus are able to give the carriers quality physicians in their network.
3. Fight for the big ticket items. Dr. Antell says it is critical for a sports medicine practice to know where to focus on fighting for the better reimbursement. This starts with analyzing where your practice makes the most money and working with insurance companies to get greater coverage in those areas because sports medicine practices won't be able to win every battle at the negotiating table.
"You can pick and choose your fights, but I'd rather fight for the bigger ticket items instead of the smaller ones like office visits," Dr. Antell says. "For example, sports medicine practices could be negotiating epidural fees for $750 instead of $500 but fall into the trap of trying to increase reimbursement for office visits from $85 to $100."
4. Hire a consultant. Another strategy sports medicine practices should consider is hiring a consultant who can negotiate better payor contracts as a "middle man." Dr. Antell says his practice works with a consultant for insurance companies not already in a contractual relationship with NYU's UPN. Consultants are often associates who formerly worked in the health insurance industry, so they are keenly aware of how to successfully negotiate better contracts, he says.
"Typically, consultants cost anywhere between $5,000-$10,000, which sounds like a big investment up front, but it's really not when you take a step back and look at increased reimbursements throughout the year," Dr. Antell says.
Learn more about Madison Avenue Physical Rehabilitation and Wellness.