Here are five Strategies to consider to maximize returns on your out-of-network reimbursements:

1. What is the best strategy to follow for out-of-network negotiations? Effective negotiations happen when providers consistently follow up and are persistent. Proper follow up includes responding to each counteroffer and following up with appealed underpayments, no matter how long they take. Vendors put up obstacles for success. Ongoing diligence is the key to successful negotiations.
2. What is the best method to negotiate with payers? Direct contact with payers over the phone is the best method, even though it is the most time-consuming.
3. Is it appropriate for vendors to give me less than a day to negotiate? Vendors often send proposals with short turnaround times. Sometimes turnaround times are valid and others are not. Make sure they validate the timeframe of their proposal. Remember, their goal is to get you to settle quickly and in their favor.
4. How do you collect more than what’s Usual, Customary and Reasonable (UCR)? UCRs are fee guidelines that insurers use to limit the amount providers can charge for out-of-network patients. Providers can use their data and examples of insurance policies to negotiate a rate they believe is usual and customary. Combat insurance companies’ tactics to pay the lowest amount possible by contracting with a qualified outsourcing partner that has access to the same data. Having the right data to negotiate with will result in higher payments.
5. What is the best way to successfully appeal underpaid bills? Providers need resources specifically devoted to appealing cases. These resources need the right type of data to make arguments to the payer. It’s important to follow a systematic plan to win appeals. Providers need to know when to correspond in writing and the timing and strategy for escalating the case. Payers and vendors put up obstacles, and persistence is the key to success.

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Phil C. Solomon is the publisher of Revenue Cycle News, a healthcare business information blog and serves as the Vice President of Marketing Strategy for MiraMed, a healthcare revenue cycle outsourcing company.  As an executive leader, he is responsible for creating and executing sales and marketing strategies which drive new business development and client engagement. Phil has over 25 years’ experience consulting on a broad range of healthcare initiatives for clinical and revenue cycle performance improvement.  He has worked with industry’s largest health systems developing executable strategies for revenue enhancement, expense reduction, and clinical transformation. He can be reached at [email protected]

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