Physicians Seek Payer Inclusion, Not Impediment

May 27, 2015, 14:30 ET from UBM Medica

NORWALK, Conn., May 27, 2015 /PRNewswire/ -- With all the daily obstacles facing physicians these days, getting paid for the services they provide to keep patients healthy should be easy. Unfortunately, it isn't always.

The ripple effect of the Affordable Care Act continues to affect the way physicians are reimbursed from their health insurance payer partners, making it more important than ever that medical practices have open and clear lines of communication with those they contract with for patient care.

Each year, cloud-based services company athenahealth reveals its PayerView® results, which rank commercial and government health insurers according to specific measures of financial, administrative, and transactional performance.  These rankings are derived from claims activity within the athenaNet ® database of 64,000 providers and provide a comparative benchmark for assessing how easy or difficult it is for providers to work with payers.

The 2015 PayerView report, which covers the largest sample of insurers to date, indicates continued gains in payer efficiencies and performance, despite Medicaid expansion and the increase in both state and federal health insurance exchange plans.

In its June 2015 issue, Physicians Practice examines how physicians can work more collaboratively with their payers.

"All we want is to be treated fairly," notes Va.-based practice administrator Lucien Roberts. "It's a desire shared by medical practices nationwide who seek partnerships with payers rather than strained relations."

To help practices work more efficiently with their payers, Physicians Practice offers five strategies to readers:

  • Don't be afraid to negotiate contract terms with payers;
  • Critically review financial data and create an ideal payer mix;
  • Use available payer tools to process claims;
  • Develop solid payer relationships; and
  • "Group up" and join a physician organization.

"There's long been the assumption that, 'There's no such thing as payer negotiations' — that what you get paid is what you get paid and practices just need to accept what is offered to them," said Keith L. Martin, content channel director for Physicians Practice. "But the reality is, armed with the right data and information to make their practice stand out from the crowd, physicians can work with their payer partners for better rates, and ultimately better outcomes for patients."

To further assist practices evaluate their payer mix, Physicians Practice presents the top 20 payers from the 2015 PayerView rankings in these categories: overall top payers; top major payers; top Blue Cross Blue Shield plans; and top Medicare and Medicaid plans.

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UBM Medica provides unbiased clinical, practical, and business information to over 700,000 healthcare providers, resulting in improved quality of care for patients around the world.  We serve our clients in the pharmaceutical, medical device, and related industries by delivering strategic, integrated communications solutions at the point of patient care – whether online, mobile, or in print. Our reach extends to practitioners and decision makers in primary care, pediatrics, cancer care, psychiatry, dermatology, endocrinology, eye care, neurology, women's health, men's health, radiology, managed care, pharmacy, and more. UBM Medica is a UBM Life Sciences business. UBM Life Sciences is a division of UBM Americas.  For more information, visit

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