MRI Reimbursement and Insurer Agreements - Full Service
Expert Negotiation Leads to the Best MRI Reimbursement and Insurer Agreements! We Assess the Managed Care, Commercial, and Governmental Insurance Payments in the Client Service Area and Negotiate Agreements for your MRI studies. - Module #12
Well-negotiated Payer and Insurer Agreements should be underway before installation of your MRI.
An MRI Imaging Center is a medical business similar to a medical practice. Billing and collecting for the MRI studies is a crucial function. Perhaps MRI services are being added to your existing medical practice, such as an orthopedic and spine surgery or neurosurgery practice.
You must set your new MRI fee schedule at the 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 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 reimbursement may be acceptable, but it may not be. You can determine this competitively by reviewing the practice insurer contracts and the MRI CPT codes you expect to bill 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 negotiating managed care contracts, accreditation of MRI magnets with insurers, and billing and collections processes 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 IDs, other identifiers, and fee schedule. As a new business, your MRI Imaging Center 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.
You will need to identify the managed care insurer group agreements you will need to participate in for your new MRI Imaging Center. Negotiations will begin several months before your final MRI Magnet “Go-Live” service startup date.
The various MRI Imaging Center payer insurance agreements can take many months to negotiate.
Resolving insurer requirements may be necessary before final contracting agreements are approved, signed, and delivered. We have extensive experience identifying insurers in a given catchment area, negotiating on behalf of our clients, and securing the best reimbursement agreements possible with insurer groups.
When you utilize our managed care contracting assistance and our strong expertise in negotiating and contracting managed care agreements in several states, you will increase the likelihood of receiving the best possible contracts 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 identifying and Negotiating high-quality Managed Care Insurer Agreements for your MRI Imaging Center, we would welcome the opportunity to use our years of experience to benefit you and your practice.
In this Module, we will address:
- The present stage of your MRI Imaging Center Development
- Is this an existing medical practice, an ASC adding MRI services, or is a new entity such as an IDTF just starting a new entity with MRI services?
- Do you currently have a billing and collections entity, or will you outsource that service?
- Have your team members previously negotiated multiple managed care contracts for MRI services and CPT codes?
- Has there been an Analysis of reimbursement rates for MRI services in the community where you intend to provide your MRI services?
- Any specific RI Imaging Niche that needs to be filled might be negotiated, with the ability to highlight Niche services such as brain, spine, abdomen, etc.
- What are the prices in your community, at Independent and other imaging centers, for self-pay MRI scans with no insurance in each of the three categories: MRI only, MRI with Contrast, and MRI with and without contrast?
- We address other questions about managed care negotiation and contracting assistance for practice areas you may not have considered.
Additional Information
Can my medical practice make money with an MRI?