If you know what you're supposed to be paid, you'll have a better chance of getting it, according to a new survey of group- practice relations with payers by the Medical Group Management Association.
The Englewood, Colo.-based MGMA surveyed 51 primary-care practices throughout Colorado and included billing and payment records for 10 commonly coded procedures.
On average, practices that had access to their contractual payment schedules reported receiving 4% higher reimbursements than those that reported revenues only off their explanation of benefits and were unaware of their contracted amounts, according to the survey.
It's a simple matter of leverage, according to William Jessee, M.D., president and chief executive officer of the trade association of group practice leaders.
Payers contract and say they'll pay according to an attached fee schedule and never provide the schedule, Jessee said. When a group asks, the payer may respond by offering to provide them with prices for maybe 20 codes but not the whole list.
"It's common practice," Jessee said. Depending on the group's market position, "A lot of people feel they don't have much choice" and accept payments without ever knowing what they're supposed to receive, he said.