Nothing gets people riled up faster than feeling like they are trapped in a bad contract—just ask anyone who hates their cell phone carrier or internet provider. But what if those contracts dictate how much you get paid for your work? The stress skyrockets. So, how often are you reviewing your third-party payer contracts? Some of you might be thinking that it’s a waste of time, considering most of them are dictated by Medicare reimbursement rates (which have been steadily decreasing for 20+ years1). We can’t really change that, right? Wrong.
In this issue, Ashley R. Geary, Esq., shares her extensive experience negotiating payer contracts for clients and walks you through the five steps of the process. (She is also lecturing on this topic at AAO on Monday, October 20, at 11:30 AM, if you are looking for more tips and tricks.) Some if it is straightforward, like staying on top of renewal dates and preparing realistic requests. But some steps (eg, making contact with the payer and reviewing the proposed contract) may test your staff’s patience…maybe have cookies at the ready during these steps. If you are willing to jump through a few hoops, you might be able to boost the reimbursement on some procedures. It’s not for the faint of heart, but if you never ask, the answer will always be no.
If you already have a system in place to review and negotiate contracts (or if this process leaves you questioning just how much longer you have to put up with the reimbursement quagmire), we have an excellent article on qualified retirement plans to help you plan.
On the patient care side, we have a wonderful article discussing the benefits of speaking a patient’s language in the clinic—and the challenges that can pose to your staff, workflow, and bottom line. Fear not, the authors provide some key takeaways to help you integrate interpreters and navigate family members eager to interpret for you.
Head over to the September issue of Retina Today to catch up on common retina coding questions answered by coding guru Joy Woodke, COE, OCS, OCSR, such as the correct coding for compounded ganciclovir and which modifier to use when billing for laser repair of a retinal detachment.
As always, we are here to help you keep your practices running smoothly, whether that’s in the back office or in the examination lane. Feel free to reach out if you have topics of interest…or if you just need to vent about your contracts.
1. Li ES, Adelman RA. Trends in Medicare reimbursement and service volume of vitreoretinal procedures: 2000 to 2021 [published online ahead of print November 8, 2024]. J Vitreoretin Dis.
