When a payer sends a low first offer on an out-of-network claim, many practices accept it. Countering takes time, tracking, and follow-up, and the offer can expire while the team is busy with patients.
But the first offer is often a starting point. Here is how PMB handled payer negotiation for Fort Lee Physical Therapy, using Multiplan and related repricing platforms.
The Problem: Low Initial Offers and Negotiation Deadlines
Fort Lee Physical Therapy had claims coming back with initial rate offers below what the practice expected to be paid. Each offer came with a response deadline, so staff needed to review it and submit any counterproposal within that window.
Three things made this hard to manage in-house:
- Time: Reviewing an offer against the billed amount and building a counter takes staff time that a busy front desk and billing team often doesn’t have.
- Tracking: Claims sit at different stages, such as an offer received, a counter sent, or a final rate returned. Without one view of all of them, claims are easy to lose track of.
- Deadlines: Tracking response deadlines alongside other billing tasks made it harder to identify offers needing prompt attention.
The Solution: Managing Every Negotiation in One Place
PMB managed eligible negotiations for Fort Lee Physical Therapy through a central dashboard. The setup included:
- One Dashboard: Each claim showed its payer, billed amount, initial offer, final negotiated amount, insurance payment, and status.
- Clear Status Stages: Negotiations were organized as Initial Rate Received, Higher Rate Proposal Submitted, Final Rate Received, and Final Rate Accepted or Not Accepted.
- Deadline Flags: The portal flagged offers expiring soon or that day. PMB reviewed them daily to prioritize responses.
- Contact History: Representative contact details, internal notes, and negotiator comments gave the team a record for follow-up.
How PMB Managed Negotiations Step by Step
For each eligible claim, the process followed these steps:
- Review the Initial Offer: The team compared the proposed rate with the billed amount and expected reimbursement.
- Submit a Counterproposal: If the offer falls short, PMB counters with supporting documentation instead of accepting it by default.
- Follow Up on the Payer’s Response: The claim moves to Final Rate Received when the payer replies.
- Record the Outcome: The final rate is marked Accepted or Not Accepted, and the final negotiated amount and insurance payment are tracked against the initial offer.
The Results
Over the past three months, PMB worked 599 claims for Fort Lee Physical Therapy through the negotiation dashboard.
| Metric | Result |
|---|---|
| Total claims managed | 599 |
| Final rate accepted | 408 (68%) |
| Final rate not accepted | 191 (32%) |
The dashboard records the initial offer, the final negotiated amount, and the final payment for every claim, so the gain from negotiating can be measured claim by claim.
What Other PT Practices Can Learn
The main lesson is that a first offer is not always a final one. Practices that treat each offer as the start of a negotiation, and track it to a final rate, can see exactly where their reimbursement comes from.
A few takeaways for other PT practices:
- Review every initial offer against the billed amount before accepting it.
- Keep all negotiations in one view, sorted by negotiation status, so none is forgotten.
- Check expiring offers every day.
- Log each payer contact and note, so anyone on the team can continue a negotiation.
- Filter results by payer to learn which ones respond to counters.
Get Support with Out-of-Network Claim Negotiation
If your practice is accepting first offers because your team has limited time to review and counter them, PMB can take over the negotiation and show you the results claim by claim.
Learn more about our physical therapy billing services, or book a free consultation to review how PMB would handle negotiation for your practice. You can also call (201) 585-7306.