Negotiating Payment for In-House Testing from Managed Care Plans
Managed care organizations (MCOs) continue to slash laboratory test reimbursements to physician offices or insist tests be referred to mega-labs for rock-bottom rates.
Physician office lab managers can succeed at convincing MCOs that near-patient testing is both cost-effective and best for the patient, and can negotiate a better managed care plan contract.
Overview
Physician offices across the country report that managed care organizations (MCOs) continue to slash test reimbursements or insist tests be referred to mega-labs for rock-bottom rates.
But most physicians who negotiate with managed care plans to be reimbursed for in-office testing can, in fact, get concessions. And as in-office testing is proven to increase the quality of care and decrease the cost of care, managed care plans may encourage – and pay for – these tests.
Physician office laboratory managers and physicians who own office-based ancillary testing services must convince managed health plans of the cost-effectiveness of near-patient testing and demand fair payment.
First, POL managers must learn the business aspects of their labs and the skills required to negotiate the best managed care contract for in-house testing they can.
All it takes is a strategy, sharp communication skills and persistence. Here's how.
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