Negotiating profitable contracts with Insurance carriers is critical to the success of urgent care centers. However, considering that Insurance companies constantly want to reduce their costs, this is easier said than done. The key is letting the insurance carriers know how by paying you more they are still going to save cost. We recommend you try these 4 tricks, if done right, these steps will help you negotiate the best reimbursement from the insurance.
Getting a contract from an insurance company, usually will take about 30-100 days or more, so keep that in mind and start the process timely. It is typically most difficult to negotiate a contract right at the beginning of your credentialing, as your worth to the community is not yet tested. However, if you have a contract and you have been part of the network for 2-3 years, you are allowed to request a fee negotiation.
In such a case, you need to show how your urgent care has benefited the insurance company by reducing the number of expensive hospital visits and save money for them. As soon as you see the need or every 2-3 years,you can submit a request for increase in your fee schedule. You should include information about changes in your overhead expenses, staff size, more experienced providers that you may have added or new equipment cost. Insurance will take their time to negotiate, no matter how much value you can project, so start well before you see the need for a hike.
Be Smart with Payer Selection
Find out about the advantages and disadvantages of joining an MCO. You should look at the rate being offered, but also at the same time make sure it is going to get you some foot fall at your center. Research the patient demographics in the area and also you can look at your own historical patient data to see what kind of insurance coverage most of your patients have. This will not only help with payer selection but also will help in showing the payer, how it is beneficial for them to get into a profitable arrangement with you, that will be a win-win for everyone. At the national level try to get into a contract with the national commercial insurance carriers.
Make your Case
For the payers to evaluate your case with due seriousness, you need to make a strong case for yourself. Include the following in your proposal:
- Outline all elements of successfully running your urgent care centers. This will include providing the overhead costs, flexibility in hours of operations, salaries of your staff, etc.
- If your center is staffed with Physicians and not PAs chances are you will be able to negotiate better rates. Clarify and highlight that aspect in your proposal.
- Show them the benefit of the benefit. Tell them that Your urgent care provides quality care option to their patients and hence saves them the money as otherwise the patients would have gone to more expensive options like the ER.
- Letters of reference from local schools or day care centers are helpful, as they can state that the Urgent Care center is a big plus for the community as they go to your center at the time of need or for Flu shots. Primary care physician/ physicians providing letter of reference stating they are comfortable referring patients to you for after hours care is also great.
Negotiation is ALL about Negotiating
You see the need for a hike in the fee schedule but don’t expect the payer to see the same. The onus is on you to make your case, present a good argument and negotiate like a pro. The payers will always want to negotiate down so make sure you ask for 10% if you need 5-6% increment in fees. They tend to meet you half-way so it is crucial that your initial quote is balanced, it does not have to be outrageously high but should be sufficient. The trick really is in making them believe that negotiating with you is in their best interest. If you are comfortably placed in the delivery of service in your community, there is no harm in adopting an aggressive strategy, by telling the payer that you may drop them if they are not willing to look into your reasonable request. However, this is a business decision and you need to carefully evaluate your position before you make such a move. Always stay close to your network representative, they are the ones that are going to present you case and are often instrumental in getting you what you need. Maintaining regular communication with them is key to success.
Payer contract negotiation for an urgent care center is difficult, there are no two ways about it, however, the better prepared you are the better the chances of success. If you have not done your homework and want to just write a letter to the insurance and see how it goes, then in our experience the chance of success is only next to nothing. There are no shortcuts, you have to do the data crunching, derive analytical high points and prepare a winning argument. Taking help from the professionals is also a good idea. Your billing service of course has more experience doing this kind of work.