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Prove Your Practice’s Worth to Payor and Reap the Financial Reward

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Prove Your Practice’s Worth to Payor and Reap the Financial Reward

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Practice's Worth

Payors may not come right out and ask you to prove your practice’s worth but being able to do so can have a significant impact on your bottom line. practice’s worth.

Proving your worth to a payor can get you reactivated after you’ve been excluded from a plan or get you in the door after a panel has been closed. Both will expand your population of possible patients and the possible reimbursements you can receive.

So, how do you get the payor to reevaluate your practice’s worth?

You have to tell them your story. You have to spell out who you are and what you do. Make sure your story is memorable and impactful. It must clearly show that by including your practice in their plan you add value to their network of patients.

Make Your Practice Stand Out Practice’s Worth.

You really need to be clear on how your practice adds value to their network. Remember, you are trying to convince them to add your practice to their network of patients. Make sure you give them a good reason.

Here are some specifics you can consider when defining your worth:

  • What you’ve done to reduce costs. Being a good steward of the healthcare dollar is a huge differentiator that can help get you back in good standing.
    • For instance, an urgent care center explained how they “do all of their diagnostic imaging in-house. This provides better care for the patient, and significantly reduces costs compared to the health system.”  The practice went on to spell out the specific savings between the cost of their imaging vs. the local health system where patients are typically referred.
  • Share the vital information that sets you apart. Tell them how many board-certified clinicians you have. Highlight a member of your team who provides a specialized service that isn’t readily available in your area. Some examples might include:
    • A pharmacist on staff could significantly help with medication reconciliations, especially with an older or chronically ill patient group.

Take some time and consider each the factors that make your practice valuable. Besides cost-savings and added services, here are a few other differentiators to consider:

  • Has your practice received any awards?
  • Do you have any quality designations?
  • Is your staff turnover low?
  • How have you helped or plan to help your community?
  • How have you helped or plan to help with COVID-19 care?

Do Your Research

Be strategic. By knowing your payor’s market position and goals, you can align your organizational goals with theirs, and show them how you can better serve their patients. Practice’s Worth.

A great place to start is to look up their Healthcare Effectiveness Data and Information Set (HEDIS) measures. This information is publicly available, and it can be incredibly valuable for you to know how they’re rated. It can really help you figure out how to work with them.

For example, let’s say the payor you are researching has a low patient satisfaction rating. You could concentrate on how you can help them boost their rating by highlighting the high customer service rating your practice has.

Go to the payor’s website, view their HEDIS measures and really think about where and how you can work together and make a difference.

Build a Relationship

Think about building a mutually beneficial relationship with your payor. Sometimes even the simplest attempts at relationship building get the momentum going. Practice’s Worth.

An observant staffer at one practice noticed that the payor rep’s name had changed in her email address. She asked about it and the rep told her she’d gotten married. This resourceful staffer sent the rep a wedding card. It was probably less than a $5 investment, but now when the staffer calls, the rep picks up the phone every time.

Remember that payors are people too. If you can figure out a way to connect on a human level, it will ease your negotiations and they will be more apt to include you in their network and let you treat their patients.

Proving your worth to a payor is only one of many ways you can get back on an insurance panel after you’ve been dropped.

For more practical, step-by-step strategies sign up for the on-demand online training series presented by contracting and credentialing experts, Olga Khabinskay, MBA, COO and Doral Jacobsen, MBA, FACMPE. This series will provide you with proven strategies to help you get your contracts and your patients reinstated. Register now!

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Meet Your Writer

Samantha (Sam) Saldukas

President, Healthcare Training Leader

Samantha (Sam) Saldukas started Healthcare Training Leader in 2012 after working as a leader in healthcare information for 20+ years. She wakes up every morning striving to help physician and dental offices improve the business-side of their practices. Her background in nursing and running her husband’s practice makes her passionate about figuring out how to help your practice succeed. More than 5 years later, thousands of practices have turned to Healthcare Training Leader for affordable, easy-access solutions to their most challenging business and regulatory issues. Some of the key topics include coding, billing, compliance, credentialing and practice management. Healthcare Training Leader guarantees the quality of every single training it offers.  Each session is backed by a money-back  guarantee of satisfaction to ensure you get what you need.