Are you receiving proper reimbursement for your Transcranial Magnetic Stimulation (TMS) services? If your contract is undervalued, you are losing thousands of dollars.
If you have not reviewed your insurance contracts within the past 12 months, this article is must-read. Insurance reimbursement policies change annually, and failing to stay updated can result in loss of revenue.
For new practices, the challenge is even greater—you might be at a disadvantage when negotiating insurance rates. Even if you have been previously contracted with an insurance under a different tax ID, contract for a new tax ID or new practice often results in lower reimbursement offers.
Negotiate TMS Reimbursement for New Practices
When reviewing a new contract, always read it thoroughly and take note of key details, such as:
- Start Date and Contract Duration
- Renegotiation Timelines
- Covered Services and Entities
- Provider Names
- Tax ID
- Taxonomy Codes
- Reimbursement Schedule
Highlight critical information and save a copy for your record. Ensure you are fully satisfied with the terms before signing, as it can be challenging to renegotiate after a contract has been finalized.
Research Needed for Successful Negotiation
When negotiating a new insurance contract, do some research on rates offered in your area for:
- Office Visits
- Telehealth
- TMS Services
- Any Additional Services
Remember that insurance companies often offer significantly lower rates for new contracts, sometimes 10% to 20% less. If the initial offer is low, negotiate the fees before signing the contract.
Covered Services for Mental Health
For mental health contracts, verify whether Televisit codes are covered. Additionally, confirm all necessary TMS codes—90867, 90868, and 90869—are part of the agreement. Finally, ensure that either code 99417 or G2212 is included to secure reimbursement for prolonged services.
Advocating for Your Services
Emphasize how your services will benefit the community and your patients. Also explain how inadequate fees may hinder your ability to provide high-quality care. Whenever possible, schedule a face-to-face meeting with provider services to discuss your request. Begin the contracting process at least six months before you plan to see patients, ensuring you have ample time to negotiate a favorable agreement.
Negotiating TMS Reimbursement Rates for Existing Contracts
If you have an existing contract, cross-check rates with your Explanation of Benefits (EOBs) to ensure you are being reimbursed correctly. Familiarize yourself with average rates for your specialty. If your rates are low, contact provider services to reassess your fees.
Timing for Successful Negotiation
Submit a negotiation request at least six months before the renewal date. Even if your renewal date is far off, consider reaching out to insurance to inquire about the possibility of a rate review. If you are within six months of renewal, take the opportunity to negotiate your contract—regardless of the rate you are currently receiving.
Setting Clear Goals
Before initiating the negotiation, clearly define the rates or percentage increase you are seeking. Physicians lose thousands of dollars annually by not properly negotiating contracts. Negotiating contracts can significantly improve your practice’s revenue.
Recommendation for Mental Health Practices
My recommendation for mental health practices is to review contracts yearly and negotiate rates to maximize reimbursement. Taking a proactive approach to contract management ensures financial sustainability and delivery of high-quality patient care.
Common Negotiation Mistakes to Avoid
- Failing to Follow Up: Once you submit your request, don’t assume the insurance company will act. Regularly follow up to ensure your request is being reviewed.
- Requesting Without Adequate Research: Before requesting an increase, conduct thorough research into your specialty fees to back up your request with data.
- Lacking Specificity in Your Request: Avoid vague demands for a higher rate. Instead, calculate and present exact figures to make your request clear and compelling.
- Giving Up Too Soon: Persistence is key. If your initial request is denied, don’t take “no” for an answer—reassess, refine approach, and try again.
FC Billing’s Expert Tips for Effective Negotiation
Negotiating TMS reimbursement rates is challenging, but FC Billing makes it simple with proven techniques and tailored solutions. Our expert team addresses common challenges such as fee negotiation and payer delays by leveraging comprehensive benchmarking, detailed cost analyses, and proactive follow-up to secure optimal outcome. With over 20 years of contracting and medical billing experience, we manage the insurance contracting process—saving you from negotiating challenges.
Here are a few tips from experts:
- Highlight the Value of Your Service: Clearly communicate the unique value your practice offers for insurance and their members.
- Provide Patient Demographics: Share an estimate of how many insured patients you treat to demonstrate your value for their network.
- Emphasize Your Unique Offerings: Discuss specific advantages your practice offers, such as highly trained staff, emergency treatment, after-hour care, and specialized services that are exclusive to your facility.
- Justify the Need for Higher Reimbursement: Explain how increased reimbursement is necessary to sustain the high level of care your patients expect and deserve.
Conclusion
Successfully negotiating insurance reimbursement rates requires a strategic and proactive approach. Avoid common pitfalls such as failing to follow up, requesting increases without proper research, or presenting vague demands. Instead, master the art of negotiation by emphasizing your practice’s value, supporting your requests with data, and showcasing your unique offerings.
Persistence and preparation are essential to securing favorable terms which enable your practice to provide high-quality care while maximizing revenue. By refining your negotiation skills and staying vigilant in your efforts, you can ensure your practice thrives in an increasingly competitive healthcare landscape.
