Health Plan and Managed Care agreements can make or break an anesthesia practice, depending on the utilization and membership ratios. Many anesthesiology providers are presented with third party payer agreements that include less than favorable reimbursement, unfair timely filing limits, flawed authorization requirements, and tricky termination clauses. Fee schedules may leave you wondering how you will be reimbursed for non-ASA codes, such as invasive monitoring and blocks for pain management; not to mention modifiers, qualifying circumstances and any partial anesthesia time units. These items clearly factor into the reimbursement for your services.
While RCM cannot predict the volume of your cases or control the payer’s membership breakdown, we can assist in obtaining agreements that address the concerns listed above. Most negotiations are tailored to our clients’ specific practice needs, however, we take these elements into consideration during any negotiation.
In 2018, RCM has been successful in contract negotiations which have benefited our physician and CRNA clients across the nation.
Some of our recent successes include:
– Timely negotiation and implementation of anesthesiology and pain management payer
agreements required for a new group facility addition
– Renegotiation of Anesthesiology and pain management agreements with national plans, with
increases ranging from 6 to 58%
– Renegotiation of Medi-Cal HMO agreement to include full base units for CRNA and uniform
rates for both provider types – representing a 25% increase for physician and 76% increase for
CRNA members
– Negotiation of blended anesthesiology rate for all member types, including HMO Medicaid and
seniors – representing a 187% increase for Medi-Cal plans, and 72% increase for seniors
– Secured preferred rates of reimbursement for HMO Medicaid members – representing a 100%
increase for Medi-Cal plans
It’s easy to become discouraged when you do not have the tools readily available to properly evaluate
your anesthesia practice or a specific payer. I am happy to assist you or your group with contract negotiations.
Please contact our office at 714-347-1000, or at synergy@rcmclean.com.
Submitted by Shauna Brown, Client Services and Contracts Manager