Requesting Higher Contract Reimbursement Rates

If you are reading this blog, you are probably a medical provider who has either heard medical insurance does not pay well or, you are frustrated with the contracted rates you agreed to with the insurance companies.

Well, I am here to share some strategies to help you maximize the amount of money healthcare insurance is paying you.

Let's get right to it. Whether you are a medical provider with a private practice or, a healthcare administrator, you should have a spreadsheet containing all Current Procedural Terminology (CPT) codes that are used to bill for the medical services rendered to patients.

The next column on the spreadsheet should have the current year and the Medicare reimbursement rates listed for each CPT code. Each column after that should start with each payor you are contracted with listing out the rates.

This will allow you to compare whether your contracted rates with commercial insurances are at or below Medicare rates. 

Understanding which insurance company pays you the most and the ones that pay you less will help you to request the desired rate to be comparable to your highest payer.  

It is also helpful to include supporting reasons as to why you are requesting higher reimbursements, for example:

• Increase in inflation
• Higher cost of living
• Current contracted rates are below Medicare rates
• The patient population served requires more time and resources 

These are some common reasons that should help justify or negotiate your new rates. If you are not doing this, then you are leaving money on the table every year. 

"Insurance companies will never give you a pay raise unless you ask or fight for it."

You might be wondering what if the insurance company decides to not increase its reimbursement rates? Well, you then can ask when are they going to assess the market to determine what the market is paying? 😁  A question to a question is fair at this point. 

It is recommended in the event your request for higher pay is denied, you try again in 6 months. The key is to not give up and keep fighting for every dollar you can get. 

Furthermore, your spreadsheet containing your contracted reimbursement rates and Medicare rates is going to be important for you and your practice financially. 

Written by: Rene Lumene