• E-mail
• Print
• PDF

Build bonds to help reduce denials

Radiology Administrator's Compliance and Reimbursement Insider, May 1, 2007

A positive affiliation with your carrier allows you to feed it vital information about imaging payment trends, emerging technologies, and the latest clinical findings for rare (but valuable) radiology exams.

And armed with that information, even carriers can see things from the provider’s point of view.

“Understanding the process of your major carriers for determining their medical coverage policies can assist you in building influential relationships with the carriers,” says Kelly Davies, director of operations for the East Region of CBIZ Medical Management Professionals in Knox-ville, TN.

Such connections help you work out potential payment problems before they ever happen.

Communicate to create connection

The first step to building a positive relationship comes from generating an initial connection and then establishing a common ground. To do so, you need to understand your payers’ various policies, Davies says. In short, she says, do the research.

Search carrier Web sites and use the institutional knowledge already at your command. You have an invaluable resource in your existing staff.

Also, ask your local provider representative for information about the carrier’s medical director and gather basic background information regarding his or her experience in the field.

Identify any underlying common concerns you share. Perhaps you both attended the same undergraduate program, or you both hail from the same native soil. Even though these discoveries may take more time to unearth, such gems often prove valuable as the foundation for business relationships.

Request a conference call with the medical director and introduce yourself and your practice or department.

“Just call and say, ‘Hi,’ ” says Mark Canada, MHA, CPC, vice president of the mid-Atlantic region for Medical Practice Management, Inc., in Richmond, VA.

Remember, says Davies, most correspondence that the medical director receives comes from the appeals process.

By that point, the relationship turns adversarial. By creating a positive relationship up front, you can eliminate that automatic negative response and improve your claims appeal success rate.

Expand discussions to the coverage policy committee

Once your carrier’s medical director knows and loves you, learn how the coverage policy committee is structured. Show the medical director how you can make committee members’ lives easier.

Give the group the gift of “real-time” experiences by offering them an opportunity to visit your facility and see first-hand how things operate, says Davies. “We live in a bubble and think everyone understands the inner workings of our facilities the way we do ourselves. But that’s just not the case. Show them you are proud of the work you do and ask them if they want to take a tour.”

With introductions complete, its time to understand the inner workings of the payer’s policies committees. Determine the following general details about committee dynamics: