“I belong to an IPA and/or have a billing company”

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Independent Practice Associations

 

Antitrust Laws – Competitors (physicians) may not agree to fix prices for their services.

Physicians often form Independent Practice Associations (IPA’s) to credential and contract with payers, with the intent of lowering administrative burdens.

However, since physicians are competitors, the IPA is not able to negotiate on behalf of its physicians. This led to the Messenger Model Contract.

Messenger Model Contract – Under the Messenger Model, the IPA acts as a messenger between individual physicians and a payer.

The messenger is prohibited at all times from;

  • Negotiating on behalf of any physician or group,
  • Coordinating individual physician responses to a payer’s offer, or
  • Sharing contractual terms among IPA members.

View an actual contract (payer info redacted). Note the Reimbursement Methodology, who is analyzing this offer for you? The IPA can’t. Note the very bottom of the contract and the last line.

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Billing Companies

 

These companies “process claims” and hopefully get you paid just as fast as possible, while providing you with billing reports.

They are processing and analyzing data given to them by you, your fee schedule, namely CPT®/HCPCS and $ Charges from your HCFA-1500.

They do not know the payment terms of your contract, they know what you give them, your fee schedule.

Practical Considerations

Whose signature is on the contract?

When a payer sends out notices and amendments seeking to change payment terms and fee schedules – who do they send them to? Most certainly not your billing company.

A proactive approach requires you to identify which contracts need attention and when based on such things as; effective date, anniversary date, reimbursement rates, etc. Information your billing company will not have.