Revenue Enhancement for a Health System-Owned Physician Enterprise
Client/Profile
Health care system with a large physician enterprise
Challenge/Situation
To assist this complex health system in quantifying the opportunity for improving reimbursement fee schedules with payers and negotiating with the payers to realize this opportunity.
The health system negotiates payment rates with payers on behalf of its owned hospitals and physician enterprise and had anecdotal information that some fee schedules were significantly low. They sought Veralon’s assistance in determining the size of the opportunity and developing a strategy for negotiating with payers to obtain a better fee schedule.
Process
Veralon worked with the billing and other departments within the health care system to assemble historical volume, revenue, and payer fee schedules for all of the employed physicians across multiple billing systems. We developed a complex data model comparing payers’ fees with regional and national benchmarks. We modeled multiple scenarios to demonstrate the potential impact of changes in fees.
Veralon prepared the health system to initiate negotiations.
We presented the size of the opportunities, by payer, to health system senior management, along with a detailed spreadsheet model. We drafted letters to each of the payers outlining the health system’s position regarding the need to renegotiate the fee schedules, and provided supporting documents.
We assisted the health care system in developing negotiating strategies for discussions with each payer. We also provided on-going support as discussions progressed by calculating the potential impact of the payer’s offers.
Results
This detailed benchmarking and analysis put the health system in a strong negotiating position, and all payers were willing to enter into discussions. All payers have agreed to fee schedule increases.