Insurer Agreements - Full Service

Determine the Managed Care, Commercial, and Governmental Insurance agreements in the client service area, and where reimbursement rates for MRI services are prohibitively low, assist in the negotiation and implementation of those agreements for all MRI studies. - Module #12

An MRI Imaging Center, is a medical business similar to a medical practice. It needs to bill and collect for the MRI studies performed. If you have MRI services that are being added to your existing medical practice, say an Orthopedic and Spine surgery practice, or Neurosurgery practice, and it qualifies as an in office exemption under the Stark Laws, you must set your new MRI fee schedule, at time of service select the proper procedure CPT code, and bill and collect under your existing tax ID number. Of course, you will want to receive the best possible reimbursement for these services. If you are an existing provider group, the insurer may simply pay you for MRI services based on the formula or rate methodology under which all the other services rendered to subscribers and their family members are paid with that insurer. That may be acceptable reimbursement, it may not be. That can be  competitively determined in the review of the practice insurer contracts and a review of the MRI CPT codes that you expect to bill out to a given managed care insurer group. We can also carve out those MRI services and negotiate a separate carve out agreement where necessary with insurer groups. We have many years of experience in the Negotiation of Managed Care Contracts, Accreditation of MRI Magnets with Insurers, and Billing and Collections process with the full spectrum of National and Regional Carriers. .

If you have an IDTF, independent Imaging Center, you will also bill and collect for services after setting up your Tax ID’s, and other identifiers,   and fee schedule. Your MRI Imaging Center, as a new business, will need to identify the various payers, insurance plans and companies selling insurance plans in your catchment area, and negotiate managed care reimbursement agreements for your MRI Imaging Center. The managed care insurer group agreements that you will need to be a part of for your new MRI Imaging Center, will need to be identified, and negotiations begun a significant number of months in advance of your final MRI Magnet “Go-Live” service startup date. The various MRI Imaging Center payer insurance agreements can take many months of time for negotiation, and the approval process can necessitate a number of issues and insurer requirements be resolved prior to providing insurer approval, signature and delivery of final contracting agreements. We have a great deal of experience in identifying the insurers in a given catchment area, in negotiation on behalf of our clients, and in securing the best reimbursement agreements possible with insurer groups. When you utilize our managed care contracting assistance, our strong expertise in negotiation and contracting of managed care agreements, in a number of states, can allow you to feel more secure that you will receive the best possible agreements and payments for your MRI Imaging Center Services.  We believe we have strong strategies and proven success in obtaining hard won Managed Care Agreements for our MRI Imaging Center clients. If you would like our assistance in setting up your MRI procedure code fee schedule, and in the Identification and Negotiation of high quality Managed Care Insurer Agreements for your MRI Imaging Center, we would welcome the opportunity to put our years of experience to work for you and your client group.

In this Consultation and Assistance Module, we will address

*At what stage of development is your MRI Imaging Center at present?

*Are you an existing medical practice or ASC, adding MRI services, or a new entity such as an IDTF just starting a new entity with MRI services?

*Do you have a billing and collections entity at present or are you going to outsource that service?

*Have your team members negotiated multiple managed care contracts in the past for MRI services and MRI CPT codes?

*Have you conducted any analysis of reimbursement rates for MRI services in the community in which you intend to provide your MRI services?

*Will you have any specific MRI Imaging Niche that you believe needs to be filled and might be negotiated with the ability to highlight those Niche services, such as  brain, spine, abdomen, etc.?

*In your community, at Independent and other imaging centers, if you were going to self-pay for an MRI scan, no insurance, what would you have to pay for each of the three categories of MRI; MRI only, MRI with Contrast, MRI with and Without Contrast?

*We can answer your many possible questions, and also discuss any interest in possible managed care negotiation and contracting assistance you might wish to consider.