A Few Questions:
Settlements – are they really that important?
Do you have a billing staff in your office?  Do you use a billing company?  Either way, those who handle your billing receive settlement requests.  How do they handle these?  Your answer is critical.  It has a direct influence on the revenue of your practice.  Perhaps you are a billing company and face the same type of challenge.  In this situation, the decisions you make are even more important, as they have a bearing on YOUR REVENUE and that of the healthcare provider you represent.
How do you handle your settlements?
Those that handle your claims receive a settlement.  Now what?  Do they guess at a number?  Do they think about the last time they handled a settlement request and assume that the same result should happen?  Or maybe they have been given specific instructions about a certain “percentage” that the office is willing to accept.  In any case, we are confident that they try their best.  But in most situations, the result is the same – YOUR money is left on the table.  And now, as you read this, you think to yourself, “Well, if that is the case, I will just tell my people to be stronger or to ask for a higher percentage.”  Sounds pretty easy, doesn’t it?  Unfortunately, that is not how it works out for the great majority of providers and billing companies.
Why can’t we do it ourselves?
The simple facts are these:  The people handling your claims lack three distinct, critical items.  However, OPES Group has mastered all three.    Let us examine each one individually to see why hiring OPES Group to handle your claim negotiations makes the best sense.
Unparalleled Experience
When most people think of negotiating, they think of buying a car. They do their research on the type on car they want and determine the MSRP. They look at their finances and finally come up with a “number”. They shop around to see which dealership might have some particular “sale”, thinking that this will help them. Finally, they enter the dealership…firm and determined to get a good deal, one that fits their pocketbook. But what really happens?


In short, they pay too much. But are happy to have a new set of wheels.


Why does this happen? Typically, because even though the buyer thought they did their research, they did not know enough. They do not know all the tricks and little catch phrases the saleforce uses to move them in the direction they want. The dealerships have a strategy, Probably more then one. And it works…every time.


The same thing happens with Cost Management Vendors (CMVs). They are like are a dealership. They know exactly what a claim is worth. They know exactly how high the carrier is willing to pay on the claim. Their job is to convince you to take as little as possible. And they get paid very well for doing so. Do you know their strategies? Are you aware of how they “change directions” as you respond to their requests? Unforunately, most do not. That is why the great majority of providers and billers leave money behind, thereby filling the insurance carriers’ pockets. However, OPEs group DOES KNOW what they do and how they do it. We have been there. Some on our team have working for the very CMVs that are trying to take money away from you. We understand the strategies that large insurers and CMVs employ to reduce claim level reimbursement. And unless you completely understand their processes, it is impossible to beat them.

Negotiation Training
Going back to our car buying experience…how often do you practice this?  Daily?  Or just when you need to buy a car?  How many people do you “practice against”?  Probably just one or two – typically yourself (mentally reviewing what you will say) and maybe your spouse or good friend.  Now, what about that person you have negotiating your healthcare claim versus the CMV?  Is that the position they were hired to do?  Most likely, they are a biller or coder, or maybe your office manager handles these.  Perhaps you even handle them yourself.  And although all effort is given to get the best settlement, how do you know it was the most you could get?
OPES Group finds that most people that handle these types of claims have never been trained in the art of negotiations.  It is not merely about having in mind a percentage or a particular number.  You need to know why your number is accurate; you need to be able to prove it.  The teams at OPES Group have been through exhaustive training specifically tailored to the medical claims industry.
Proprietary Software
Consider how those currently handling your billing track each claim that is negotiated.  How do they keep track of every one?  Typically, they don’t.  They go from one claim to another, working each settlement individually.  And while you may think you are doing quite nicely with your negotiations, how do you really know?  Honestly, how do your claims compare with the provider that is doing the same procedures, on the same types of patients, right down the street?  You might claim that you get a certain percentage on every claim you negotiate.  A percentage is very relative.  It does not really speak to the individual nature of the number you are working with.   Are your billings high enough?  If you get 70% of $1,000 or 70% of $10,000, the actual amount in your pocket varies considerably!  Even with the best tracking system for you individual claims, you still cannot track the claims of others.  That is where OPES Group excels.  We track hundreds of data points on each claim that our clients provide us.  You benefit by our unique systems as we use other providers’ claims to increase your revenue!  We have created proprietary software with its associated algorithms that enable us to determine the best negotiation strategy.  Have OPES Group work YOUR claims and see an increase on your claim reimbursements
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