Negotiate better Reimbursement Rates for Urology

November 15, 2016


The very existence of a practice depends on the reimbursement rates, and Urology medical billing is no exception. It's the reimbursement rates that make or break a practice; hence there is a need to be careful while negotiating the reimbursement rates in order to be profitable and successful. The sad part is that, there is hardly any match between the skills and ability of a physician when it comes to reimbursement rates – It is the insurance companies who present alarmingly low rates and most practices accept them as they need more new patients in order to survive.

However, the fact remains that physicians have a right to negotiate and renegotiate the rates for which they need to determine what the insurance companies expect and what the physicians deliver. While the insurance companies are more interested in earning dividends for their stakeholders and would cut corners and costs wherever possible by paying the lowest rates possible, physicians are more interested in delivering the best treatment to their patients. At least most of them do, if not for a few who are more worried about the reimbursement.

Urology medical billing providers are aware that most of the practices and physicians are an asset and may have to compromise on rates in order to stay in business. Getting better reimbursement rates is not as simple as asking for a raise. You need to back up your request or demand with hard facts comprising numbers, figures and even arguments supporting them. Such a strategy will put off the most stubborn insurance payer who will find it difficult to refuse.

The Value Based Payment Modifier (VM) comes as a saving grace for Urology medical billing as its main intention is to make a true assessment of quality care along with the matching costs involved. The Medicare Physician Fee Schedule (MPFS) comes handy in deciding the true worth of a physician's services as it takes into account specific program components. It is not just the physicians who stand to benefit by the MPFS, even non-physician EPs like PAs, NPs, CRNAs, and CNSs who will be billing insurance companies using a group's TIN or even if they are independent practitioners.

Of course, the implementation of the Value Based Payment Modifier will largely depend on the Physician Quality Reporting System (PQRS) which is convenient and easy to implement. While the beneficiaries stand to get quality care, the physicians' reporting burden is not increased while the quality performance is reported. Apart from the quality measurement component the VM comprises three other measures that the CMS looks out for. They are acute conditions that warrant hospital admissions as well as chronic conditions that may extend to a 30-day hospital readmission, which Urology medical billing companies need to take not of.

Moreover, the cost measure component of the VM also includes six other cost measures.

  • The total Per Capita Costs of All Attributed Beneficiaries Measures
  • Similarly, total Per Capita Costs of Beneficiaries with Specific Conditions that include
    • Diabetes
    • Coronary Artery Disease
    • Chronic Obstructive Pulmonary Disease
    • Heart Failure

Most of the Urology Medical Billing and Coding Services are aware that some PQRS urology measures stand deleted while the IMRT and prostrate biopsy codes have been revised. It is mandatory to comply with EMR certifications lest you don't mind paying penalties for not complying. Of course, complying helps you achieve bonuses. Sustainable Growth Rate (SGR) cuts are probably here to stay, and loom large over the horizon. One only hopes that the authorities (read Congress) will do the least bit on their part by blocking the SGR one more time.


Category : Best Billing and Coding Practices