A Presentation For The CDC Billing All-Projects Webinar Negotiating Reimbursement Rates With Third Party Payers 3/24/2015

Six Steps To Negotiating Reimbursement Rates 2 Vaccines Clinic Services Assess Costs Fee Analyzer Federal, State and Local Compliance Review/Update Fee Schedule Prioritize Fee Schedule Know The Payers

Six Steps To Negotiating Reimbursement Rates 3 Think Like a Payer Clinical Services Provider Profile Develop Leverage Develop Relations Tracking Tools Persistence Contact Payers Determine Timelines Renegotiate

Assess Costs 4 Purchased Vaccines – Administrative Functions Involved Administration of Vaccines Clinic Services if Appropriate

Review/Update Fee Schedule 5 Federal, State and Local Rules – Ensure Compliance Fee Analyzer – Customized to Local Area – National Medicare Fee Schedule

Know The Payers 6 Prioritize Fee Schedule – Usual and Customary Rates – Percentage of Medicare Fee Schedule Review The Landscape – Third Party Administrators – Managed Care Organizations – Preferred Provider Organizations

Develop Leverage 7 Think Like a Payer – Would You Be Familiar with Public Health Departments? Capture All Clinic Services Sell The “Why” Clinic and Provider Profile

Contact Payers 8 Develop Relationships – Customer Service Approach Tracking Tools – Database – File Folder Persistence – Overcome Barriers

Renegotiate Reimbursement Rates 9 Purchased Vaccines – Cost Fluctuation Clinic Services – Annual Review

Athina Kinsley Health Insurance Specialist 10