Nurturing Payer Relationships: Getting Your Just Desserts - Part II

Click here for Part I

It’s a lot of work to implement change, but poorly run practices are also a lot of work.

- Judy Capko, Capko & Company

The Hassle Factor

If you make the efforts prescribed in Part I, and you’re still not gaining much traction with your payer, you might want to consider the Hassle Factor.

Judy Capko developed this quick ratings system to help give physicians a better idea of the health of their relationship with individual payers.

Hassle factor ratings assign one point to five indicators, with a higher score being a worse performance; zero is best rating.

Indicators

  1. Does the payer require repeated requests for referral or authorization?
  2. Does the payer slow down your claims processing?
  3. Does the payer make errors in claims processing?
  4. Do patients complain about the company?
  5. Is provider relation support substandard?

Dropping Contacts

If a particular payer has a Hassle Factor rating of a 4 or 5, and their reimbursement rate is not that great, you might want to consider dropping coverage through that provider.

Of course, even if your relationship with a payer is strained, you still want to take a few things into consideration:

What will the impact be on your practice?

If a particular payer is the biggest game in town, you’re probably going to have to suck it up or risk losing patients and revenue.

Will dropping coverage mar your reputation?

Be aware of the company’s standing in the community; you may not like it, but your patients might. Further, even if a patient doesn’t like their insurance provider, they may have no other option. Dropping coverage will be convenient for you, but not for them. You don’t want a reputation as someone who doesn’t provide good service to their patients.

If you do decide to end your relationship with a payer, make it a smooth transition for everyone. Abide by the contract terms and give everyone, patients and payer, reasonable notice of your intention.

Ensure that you clearly communicate the reasoning behind your decision to your patients and offer them as much help as possible. Offer to see them out of network and bill their insurance. If you nurture the relationship, the patient may decide that you are more important than their insurer and decide to stick with you. If the patient does decide to leave, refer them to a new physician and help transfer their files.

Tap into resources

Even if you fully understand all of this information, acting on it is a different animal altogether. If you’re having fits and starts, or are feeling too overwhelmed to even begin, turn to someone for help.

From educational courses, specialty societies, and medical associations to healthcare management periodicals, employer relationships, and other professionals, there’s a whole world out there waiting to lend you a hand.