How to Use the Right Words to Maximize Reimbursements – Success Story Part 3
Legalese, bureaucratese, and general communication style expectations are often sources of frustration and anxiety when you are trying to get something done outside of your area of expertise. Even the highest level of proficiency in the language of your field does not directly translate into the contractual language related to your field. If your healthcare organization is trying to navigate the murky waters of health plan contracts, United Physician Services is both your compass and life preserver.
A Case In Point
A surgical wound care organization came to us after having tried various methods to secure a large government health plan contract. Upon showing us their contract, we were easily able to identify why.
Contractual Language Needs to be in your Best Interest. Most small to medium sized practices believe that they do not have any negotiating power to negotiate the contractual language or request a reimbursement increase. If you are one of those believers, then you are wrong.Even the most well-written and positive-sounding contract can have aspects that are not in the best interest of your medical facility. To ensure the language is really in your best interest, it takes:
- Knowledge of health plan expectations
- Insight into health plans’ internal decision making processes
- A framework of contractual flow and organization
- Awareness of policies, protocols, and regulations that affect health plan contracts
Upon looking at our client’s contract, we were able to edit the language to incorporate our expertise in these areas to ensure the language was always in their best interest.
The Right Language Pays. By editing the contract, we were not only able to negotiate the contract’s terms, but we were also able to secure an increase in reimbursement for them. This increase in reimbursement was 52% of one of the health plan’s lines of business. Being a government contract, this is highly significant, especially since government contracts are considerably harder to negotiate than commercial products.
Let us Fight for your Payback. Many of the Medicaid plans are now being delegated and are being managed by the large commercial health plans and for those of you that accept Medicaid patients you need to make sure that during this transition you are not left without a contract. Is securing a government health plan contract one of your goals? Let us help you ensure your contractual language meets your practices needsand will get you not only the contract, but also the reimbursement you are looking for.
Call us today at (602) 685-9500 or email us to schedule a free professional consultation. In our 30 minutes together, our qualified senior contract negotiators can answer your questions and determine what opportunities we can create together.
Find out More about what we were able to accomplish together with the surgical wound care organization by reading “Contract Secured- Success Story Part 1” and “We don’t take ‘No’ for an Answer- Success Story Part 2.”