Practical Tips to Better Negotiate Insurance Reimbursements

Few things are as frustrating as negotiating reimbursement for healthcare services. From getting lost in the system to dealing with issues like coding and medical necessity, this process can leave you feeling confused and even angry.

However, there are ways to make the process easier for all parties involved and ensure that your billing cycle is smooth. In this post, you can go over some tips for negotiating insurance reimbursements effectively so that you can get paid what you deserve:

Understand How the Insurance Reimbursement Software Works

If you don’t understand how insurance reimbursement software works, it can affect your ability to negotiate reimbursements effectively. And if you’re not fully utilizing the capabilities of this software, then it’s costing you money. Understanding how the system works can help save you time and energy and ensure that your reimbursements are accurate and up-to-date.

Consult an outside expert if you aren’t sure how to use this software for proper reimbursement tracking. It can help ensure that all information is recorded accurately, so there are no mistakes later when collecting reimbursement. It’ll also help keep track of all expenses incurred during treatment, so nothing gets missed out on later.

Keep a File of Clinical Data

If you have a question about reimbursement for a procedure, keep your clinical data. It is vital if there are any disputes between you and your insurance company. Keeping clinical records can also help you when an insurance company or another party performs an audit. These parties can question the legitimacy of your claim.

There are guidelines for medical institutions in the US about keeping patients’ medical records. However, the laws can vary from state to state. For example, it is mandatory in New York to maintain the records of a patient safe for a minimum of 6 years from the date of visit.

Remember that while this tip might seem obvious, it’s necessary not to overlook it. You should always keep good notes on treatment plans, patient progress, and follow-up care.

Pay Attention to the Details

There are many ways to submit claim information and paperwork, but not all are useful or necessary. When submitting a claim for reimbursement, be sure you are using the billing codes and documentation. According to a report published in RevCycleIntelligence, $20 billion of reimbursement is lost or delayed yearly in the US due to wrong coding.

Remember that the exact name of a diagnosis code can vary from one insurance company to another. However, as long as you include it somewhere on your paperwork, they should be able to find it enough. Similarly with procedure codes, while they may vary slightly from insurer to insurer, there’s usually only one way that works across the board.

Be Diligent About Keeping Track of Your Time in Case of Disputes

To ensure you are paid correctly and consistently, you should keep track of your time safely and securely. You should have an accurate system for tracking your time. If you don’t already have one, take the time to set up a system that works well with your business needs.

It’s also wise to keep track of mileage since many companies reimburse based on miles driven when taking clients from one location to another. It is an excellent way to avoid a dispute between you and the insurance company. Sometimes a dispute between the insurer and you arise over the percentage of travel expenses; in that case, you have documentation showing how many miles were driven.

Make Sure You Know What You’re Entitled to Before You Negotiate

Before you negotiate, ensure you are fully aware of what the insurance company will pay and what they won’t. Most importantly, you should know how much the insurance company will reimburse you for each treatment. The details of this can vary depending on your plan and the type of treatment provided.

For example, if you need surgery to repair torn ligaments or a broken bone, your reimbursement rate may be higher than if your doctor prescribed physical therapy. Many health plans require that all surgeries be pre-approved by them before they will cover them as part of their benefits package. It is another crucial detail to know before negotiating with the insurance company.

Use the Facts of Your Specific Situation to Your Advantage When Negotiating

Now that you know the three steps to negotiating insurance reimbursements, it’s time to implement them. But before you do that, remember that it is necessary to use the facts of your specific situation when negotiating.

Using facts about your specific situation can also help protect yourself from getting ripped off by insurance companies. They try to inappropriately deny claims or reimbursements due to their policies which may require them to pay less than fair market value.

Consider Hiring an Outside Negotiator

Consider hiring an outside negotiator if you have a complicated or lengthy negotiating process. Negotiations are often time-consuming and emotional. By hiring an expert negotiator, you can get back to running your business without worrying about delays in communication or other issues that may arise during the process.

The negotiator will also have the experience and knowledge to know the right questions to ask, how to frame your case and how to deal with difficult situations. A good negotiator can help you reach a fair settlement for everyone involved.

Don’t Give Up if the First Attempt at Negotiation Fails

You may find the first attempt at negotiation unsuccessful. However, it is not the end of the story. According to the industry trend, nearly two-thirds of rejected claims are recoverable. However, according to other data, 86% of denials are avoidable. Therefore, if you could get an insurance company representative to talk with you, they are interested in working with you and respecting your needs as a patient.

It’s necessary that if there is any chance for negotiations, keep trying until one succeeds. Don’t give up on this process because it takes time and effort on both sides of the table.

It’s important to remember that when an insurance company representative talks with you, they are not your friend. Their job is to be the middleman between you and their carrier. Therefore, they have no incentive to give you a good deal on your medication. Therefore, it makes it more crucial to know your rights and how much to pay for your prescription drugs.

Final Thoughts

For insurance reimbursement to go smoothly, do your homework. Make sure that you understand how the software works properly. Keep a file of clinical data related to your patient’s condition and treatment plan. It will help you with billing disputes later on.

Finally, pay attention to the details. Every little bit counts when getting paid for what you’re owed. Keep track of how long each procedure takes and how much time was spent waiting for a result before filing an invoice. It will ensure that no one can claim their reimbursement was too high because they didn’t know what they were entitled to from the outset.

The most important rule of insurance is that you should always make sure you have enough coverage for unfortunate events that may happen. Insurance companies can be tricky, and knowing how to work with them is necessary to ensure your premiums don’t go up.

Adam Hansen

Adam is a part time journalist, entrepreneur, investor and father.