Don't Get Bullied

Are they trying to bully you too?

When mail comes from an insurance company, I expect it will be a check and checks make me happy.  But when it is something else, it always seems to be something that makes me unhappy.  I have found that “news” from a third party payer is rarely good. 

In the recent months, some insurance companies have been sharing some news with me that I, at first, thought was good.  They let me know that compared to “other physicians within my specialty,” I bill at a higher level.  This is good to know.  I feel like we deliver high quality care and accept a lot of complex cases.  We are diligent, we work hard and here’s proof that we do it better than others.

But the letter was not to congratulate me on my diligent care, it was to threaten me.  The letter went on to say that they are going to keep watching and if I don’t fall in line with everyone else, they might be forced to investigate.  They then said that this investigation would be disruptive to my business and if they catch me doing wrong, I would be in big trouble. 

We work hard to make sure that we are billing appropriately.  We take classes, read updates, and use software within our EHR to ensure that our coding is correctly done.  We don’t do unnecessary tests, we incorporate testing protocols and we do what is right for the patient, every time.  We utilizeRevAssure, which audits a sampling of our records every month and incorporate changes based on feedback from our specialist. 

So, here is the journey through my reaction to this bullying letter:

1. Pride – “Thanks insurance company for acknowledging our excellent work.”

2. Disappointment – “Hey, you’re not being cool about this.”

3. Fear – “I don’t want my business disrupted or to be punished”

4. Doubt – “Maybe we should start billing with lower codes?”

5. Awakening – “Hey, wait a minute, they are just trying to scare me, and it worked.”

6. Anger – “I am from the South and I will whip your ass, bully insurance company.”

7. Realization – “This is just an intentional, controlled tactic to reduce their expenses.”

8. Defiance – “They are not going to scare me into breaking the rules for their benefit.”

9. Self – Confidence – “We work hard to do it the right way and we do it well.”

10. Dedication – “Let’s use this as an opportunity to stress to the team the importance of billing.”

11. Commitment – “We will stay focused on doing it well with the partners we have in place.”

12. Welcoming – “Come sip some sweet tea while you investigate all you want. Sorry about #6.”

Here is the lesson: Don’t back down just because a bully comes knocking. Do be ready to stand up to him by making sure you can back up your billing with solid documentation.  Bullies are less scary when you are ready to stand up to them - just be ready.

Keep up the good work, 
Mike

p.s. I am sure that I am not the only one receiving these letters. Share your story here.

"TCI" is "That Crappy Insurance." Do you take it?

The ongoing question in all of eye care: “Should I accept (or drop or keep taking) TCI?"  T.C.I. is an acronym for “That Crappy Insurance”; you can insert any of the ones that we consistently discuss here.  The reason we continue to discuss it is that it isn’t clear what will happen if we change. 
 
Here’s what we know:

1. They don’t pay enough for the services we provide and they often create limitations in what we are able to provide to our patients.

2. Many of their clients will choose someone else for their eye care if we are not on the list.

Like the little angel on one shoulder and the devil on the other, we argue with ourselves, unsure of the right decision. 
 
I have never heard anyone say, “We dropped TCI and it was the worst thing we ever did.” 
 
In its simplest form, the decision to be in or out of a given network depends on two factors and can be decided with a simple four quadrant grid – also known as a Kapperman Grid.  The two questions are: Does the given insurance pay well or not well? And - Is the practice patient schedule full enough or not full enough?As illustrated on Table 1, you can see that an insurance that pays poorly in a practice who has a schedule that is full enough lands in Quadrant 1.  The obvious decision is to Drop the Plan.  Whereas a plan that pays well in a practice that needs to fill up its schedule lands squarely in Quadrant 4, making the decision easy to Keep the Plan.  Quadrants 2 and 3 are less clear about the decision.
 
Note that this grid gives you the decision in its simplest form.  There are many other factors to consider in a given community and practice.  These factors may include how many people in the community have TCI or what medical plan is associated with it. 
 
Private Pay patients are not yet a thing of the past, but they are becoming less common.  We must be careful to not let our practices become enslaved by these plans that tighten the reigns more and more every year.  If you find yourself cutting corners so you can take more plans, consider that you may be doing a disservice to the people that are willing to choose you over their plan. 
 
If you do decide to drop a plan, read this idea about how to capture as many of those patients as you can.
 
Thanks,
Mike
 
p.s.  Have you done this lately?  We would love to hear your story…...

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