ARTICLE
Although no practice wants to reach a point where they need to “break up” with an insurer, a few measures taken beforehand will make the process easier. None of us really want to be there, but there are times and situations and circumstances in which you have to do it. Although a too-low reimbursement rate is one of the more obvious reasons for canceling a contract, there are other reasons as well, including a too-high administrative burden and unreasonable methodologies the insurer uses to calculate rates. Some of these things are so inflammatory and that’s where the decision to terminate commonly arises. When considering whether to terminate the relationship, the first thing to do is consider the revenue impact. Financial comparisons are really important. When you can show charts showing they’re not even getting reimbursed for the costs for their services, it’s really easy to understand. It’s vital for the owners to make sure everyone is on board. Alignment and short-term and long-term goals need to be part of that analysis. One group outlined their six-step approach to the problem: Figure out what's driving the move to terminate the contract Collect the appropriate data Get buy-in from everyone on the team Notify the payer of the intent to terminate Manage the ongoing patient relationship Develop and follow a communication plan If you back up emotional decisions with objective data, it can be a pretty easy answer. Source: https://www.medpagetoday.com/practicemanagement/reimbursement/82750