Difficult interactions and strained partnerships between physicians and healthcare payers is certainly nothing new. In use for decades, the current payment model seems simple on the surface, but a closer look reveals a number of issues that significantly complicate physician/payer relationships. Becker’s Hospital Review recently pointed to the filing of inaccurate or incomplete claims and the over- or under-charging for medical services as just two reasons for the current disconnect between physicians and payers.

Medical Economics Reports

A respected news hub for healthcare industry professionals with trusted news stories that cover all facets of the medical business, Medical Economics has also published a number of articles on the physician/payer divide. A March 2017 piece by Medical Economics contributor Todd Shyrock echoed the complaint of countless medical professionals, stating that “physicians looking to negotiate reimbursement rates with payers often find themselves dealing with take-it-or-leave-it offers, leaving them feeling frustrated and powerless.”

The article went on to quote a Medical Economics Payer Scorecard survey that shows just how pervasive the problem is. When asked to rate how challenging there current payer negotiations are, 64 percent of physician respondents gave the issue four points out of five with five points representing a situation which is “very challenging.”

Simple Physician-Based Solutions

Medical Economics recently went straight to the heart of the physician/payer divide by publishing the word-for-word opinions of medical professionals from coast to coast. Conducting a poll that asked well over 1,000 physicians to share their day-to-day experiences with insurers, Medical Economics received frank input on just how frustrating interactions with payers can be. However, the poll also looked forward to a more positive future for physicians and insurers alike. 

When asked to highlight major areas of potential improvement in physician/payer interactions, physicians pointed out many systematic problems that may take years to fix. In fact, one respondent felt strongly that insurance payments will be unlikely to improve unless the United States adopts a single-payer national healthcare plan, bemoaning the fact that, in light of the current political climate, this may take another two decades to accomplish.

But, while complaining of the deficiencies of a “counterproductive” and “obstruction-oriented” payment system that is “bureaucracy at its best,” these same physicians offer a number of solutions to the payment industry that are much simpler to implement. Here are just a few physician-derived tips to improve the physician/payer relationship: 

• Offer greater transparency in fee schedules, reimbursements, and reasons for denials
•  Simplify the pre-authorization process
•  Always pick up the phone so medical professionals can reach a real person during normal business hours
• Ensure prompt service and submit payment for physician fees within two weeks
• Accept penalties when your insurance organization fails to pay the proper physician reimbursement
• Rather calling or emailing only when asking a physician to take a mandatory survey or pay money back to your compnay, consider contacting medical offices simply to check in, solidify productive working relations, and ask how you can provide better service
• Authorize a greater variety of medications and make certain that you are covering the best and cheapest medications on the market
• Make use of modern technologies that allow providers to scan the insurance cards of each patient at the time of medical service, eliminating the potential of future denials
• Interfere less in the intimate and trust-based relationship between physician and patient
• Work more closely with physicians to promote quality patient service and fair pricing

For More Information

Working with a wide range of medical practices M-Scribe Technologies, LLC, provides range of medical billing and coding solutions to greatly simplify the payment process. Our team of experts has a long history of streamlining operations to improve the physician/payer relationship. For more information about our services, call me today at 770-666-0470 or by email at patrick.dougherty@m-scribe.com.

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