How much do you haggle w. insurance companies?

[Therapist4Chnge]

It seems like I'm dealing more and more with insurance company BS, so I'm trying to get a handle on what is "typical". I have a quasi-PT neuropsych practice that services a large metro area. I have limited myself to 4-5 private insurance carriers (in addition to Medicare and Worker's Comp) and I purposefully avoid the carriers with bad reputations and those that have lower reimbursement rates. So far that has worked well, as there is a lot of work out there, but every week it seems like another insurance tactic is invented to delay/deny payment. I'm now starting to see some of the stuff I was trying to avoid…'pre-auth' forms that I need to fill out, unrealistic caps on total # of hours for an assessment, etc.

What is everyone seeing out there?
Do you require pre-authorization? (even if it isn't 'required')
Have you had success haggling with your carriers?
What is your turnaround time for getting paid?
Have you been able to do a "per case" contract with a carrier?

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[smalltownpsych]

The insurance companies are really good at these tactics. My experience has been that a good office support person is invaluable. Of course, I might be biased in that respect since my wife has done this in the past at a community mental health center. She learned how to jump through their hoops and get the right documentation. At the facility where she worked, she was able to increase the reimbursement revenue by about 50% with no increase in amount billed. She can be a bulldog and that's what it takes. My plan is to have her work with me some day when I am ready to start my own company.

 

[PsyDr]

I take exactly two insurances. Everything else is out of network.

1) My office pre-auths everything, except for medicare.

2) My clinical practice is VERY specialized. In my three practice areas, I am one of two in a metropolitan area. M office tells insurances either they pay, or we won't see their patients. For hours, I cite the published research. It has never been a problem. Some of the crappy panels have repeatedly asked me to join their panel, but it makes no financial sense. I also give away about 30 pro bono cases a year. A few years ago, I was giving away more than double that, but I started to resent the docs that would only call me for a favor.

3) My turnaraound time is "whenever my office manager gets around to it". I treat my employees like I would want to be treated. Everyone gets their work tasks assigned each morning. Once this list is complete, they can go home. Unless there are office treat days.

 

[Therapist4Chnge]

@PSYDR , do you pre-auth for Medicare managed by Aetna/BCBS, etc.? I'm still trying to figure out what is needed for managed Medicare and Obamacare plans. My staff seems to have a good handle on things, but I still try and stay up on the particulars.

@smalltownpsych we are tweaking our "in office" process to try and cut down on re-submissions and other hurdles that often shrink overall revenue. We are lucky to have some great staff and a good billing company, as I know it can be much worse than we have it. I try and stay out of all things pre-auth & billing because that stuff irritates me, but I still need to get involved with certain cases. Being able to avoid the really bad (administrative) cases has been helpful, as every hour spent doing paperwork is another hour I can't see a pt. and get them eval'd.

 

[PsyDr]

I hate medicare replacements. I'll pre-auth them, but they have declined payment after pre-auth. I then report them to the state insurance commission. Kanter has a billing listserv to which you might want to subscribe .

 

[Goobernut]

Oh I loathe Medicare replacements... It's a good thing I'm on my iPad or I'd probably drone on and on. For disclosure, I did medical billing and coding (not just office visits) as well as reimbursement analysis. While psych billing is a little different, insurance companies pay the claims and have the same rules for mental health, dentistry, and health.

I can answer one question that t4c asked that hasn't been addressed. Claim payment time is highly variable depending on carrier. Medicare -- is ironically one of the fastest. Most private insurance companies (non HMO contracts) should pay in 30 to 60 days. Tricare is a glacier. They take up to 6 months on the simplest claims, neuropsych prolly sends them into fits.

There are several areas where billing can drag, some of that is in documentation lag. For example, the surgeons that I worked for were forced to use the hospital transcription service and it was terrible. They took 2-3 weeks to transcribe. I would almost hit our 30 day window on some of the HMOs that we were contracted with.

I'm unclear on the pre auth question. Are you saying you have to fill them out (or your office staff) needlessly because some is asking you to even though you know you don't need to, or are you saying pre-auths are long and tedious forms in general? Or at you asking if people as their patients to get a pre-auth even though it's likely their insurance may not require it?

Pre-auths in general are a systemic problem. You can call the insurance company, they will tell you they don't need a pre-auth, then deny for not having one. If you get one and don't need it, all your office staff wasted was 5 mins of a rote task (once the process is running smoothly). In offices I was in, this was solved by having experienced office staff do the majority of the call/paperwork, and then leaving as little as possible for the professional. What I mean is that the specialist's office will call and check and attempt to get a pre-auth if necessary in advance. Is your complaint the time/energy it takes to get a pre-auth? Which I'm not belittling -- some offices have a person dedicated to this task only.

 

[Therapist4Chnge]

I hate medicare replacements. I'll pre-auth them, but they have declined payment after pre-auth. I then report them to the state insurance commission. Kanter has a billing listserv to which you might want to subscribe .

Is that the MHBilling list serv? If so...I read it.

 

[Therapist4Chnge]

I can answer one question that t4c asked that hasn't been addressed. Claim payment time is highly variable depending on carrier. Medicare -- is ironically one of the fastest. Most private insurance companies (non HMO contracts) should pay in 30 to 60 days. Tricare is a glacier. They take up to 6 months on the simplest claims, neuropsych prolly sends them into fits.

I frequently get requests/referrals for neuropsych evals through Tricare, but their cap on assessment hours is annoying. Evidently a provider can ask for an exception, but that just invites for more time wasting to go back and forth. I haven't checked their rates this year, but I'm guessing they aren't great.

I'm unclear on the pre auth question. Are you saying you have to fill them out (or your office staff) needlessly because some is asking you to even though you know you don't need to, or are you saying pre-auths are long and tedious forms in general? Or at you asking if people as their patients to get a pre-auth even though it's likely their insurance may not require it?

Is your complaint the time/energy it takes to get a pre-auth? Which I'm not belittling -- some offices have a person dedicated to this task only.

There are 2-3 questions worth of inquiry in my one vague question. Many private insurances still require pre-auth for neuropsych, though some actually have a form that they require be submitted with the request. The forms vary on the level of detail, but I've seen some that literally ask for every test you want to administer and an estimate of how long each one will take to administer and score. I was curious if people actually fill those forms out. I typically don't and have my admin call, which usually sorts things out bc they mostly want the CPT codes.

As for the other questions….yes, I have my staff secure a pre-auth (or document the attempt & response), as insurance companies are generally slimy and despicable in their practices when it comes time to pay.

No to the question about getting patients to get pre-auth. In a rare instance a patient will call their insurance company to complain if our initial request for coverage is rejected, though that rarely goes anywhere.

I agree that the entire system is junk, but the insurance lobbyists were far more effective than patient and provider lobbyists, so we are stuck with the current system. Eventually I'm going to go only Fee For Service, but it isn't a viable option in my current setup.