Evaluate, improve, repeat

Monday, November 23, 2015

ATLANTA – With the proliferation of competitive bidding and fickle third-party payers, providers need to evaluate their best practices regularly, says Miriam Lieber, president of Lieber Consulting.
“Even if your business is doing well, it could be doing better,” said Lieber at Medtrade in October.
One of the things Lieber recommends providers do: Review their contracts with third-party payers on a regular basis.
“They breach their own contracts,” she said. “You might have to submit a claim within a timely filing period and then they don’t pay you for 150 days, but they’re supposed to pay you within 45 days. If you read the contract and you find that’s not allowed, you can go back to them and say, ‘This isn’t working.’”
It’s also important to pay attention to the fine print on contracts, especially once Medicare phases in reimbursement cuts in non-bid areas on Jan. 1, 2016.
“Maybe (the contract) says they’ll pay a percentage of the current Medicare fee schedule,” she said. “If it pays 80% of that rate, do you want to be in bed with them? I don’t think so. You better go and look now so that you can go back to the drawing board before 2016.”