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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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