Physicians Need New Approach to Managed Care Contracts

Denials are increasing as payers are seeking ways to improve their bottom lines in a tough economy, says Moorehead. As always, they hope some percentage of the denials will never be challenged. Combine that with the changes in CPT codes that will increase the work required to submit claims, and you have to consider more than just dollars when evaluating a managed care contract, he says.

Too often, Moorehead says, physicians simply accept what is offered without looking at the true cost of a contract. It's not just about reimbursement anymore, he says. It's about process engineering.

"A carrier comes out with a fee schedule and the reimbursement is down. Well, bad enough, but then they're also implementing these processes that will increase your workload and increase the denials from 5% to 15%," Moorehead says. "Most people just say 'yes' and 'thank you.' You have to look at this from a completely different angle in today's world. Times have changed. Wake up."

This article appears in the July 2012 issue of Managed Care Contracting and Reimbursement Advisor