How to Build Relationships with Payers and Referral Sources
on December 07, 2020
By: Craig Douglas
As you look to build relationships with any business partner, whether it be the payers you contract with or the referral sources that you rely on to refer patients to you, the process has to start with two key thoughts in mind:
- They have to believe that your #1 goal is to make them look good, and
- They have to believe that the things that are important to them are also important to you.
If they tell you they want things done a certain way, that is how they expect that you do them. If you have a suggestion for a better way, or a reason their way won’t work, you need to have a strong and convincing argument as to why that way is better. There is no harm in showing them why you’re the expert when it comes to providing your products and services, as long as it’s done professionally.
If you expect either of those entities to send their member/patient to you, they need to know that you are going to take great care of that person and that their customer isn’t going to call them a day, a week, or a month from now with a myriad of problems saying “I can’t believe you sent me there.”
While there are many similarities, there are also some differences between building a relationship with a payer and building one with a referral source. While a payer can also be a referral source, for the purposes of this article, we will define referral sources as physicians, hospitals, rehab centers, etc. that are treating patients themselves and referring them to you for the products and services that you provide which are beyond the scope of what they themselves offer. I realize that there are also risk-based models out there where a referral source, such as a physician group or hospital, can also serve as your payer, but that is a topic for another day.
Let’s start by looking at some key components of building a relationship with each entity type.
When it comes to referral sources, the list of things that are important to them usually boils down to some combination, or perhaps all of, the following basic needs. There are certainly other factors that aren’t addressed below, but we will start with these for now:
- Responsiveness – When they send you a referral, they know you will verify it is received and respond with a “YES” or a “NO” quickly. Obviously, the more often you can say yes to their requests, the better. We’ll expand on that topic further in a moment.
- Timeliness of products and services being delivered – If they request that a product/service be provided to a patient by 2:00 that afternoon, it better be there by 2:00, or you better have a very good reason as to why it can’t be, and when you WILL have it there.
- Reliability – They know that if you accept a referral, you will provide what is needed (according to the orders, plan of care, etc.), where it is needed, when it is needed, etc. It’s not going to fall back in their lap to coordinate with someone else because you couldn’t follow through. They want a “YES” to mean “YES”, not “MAYBE”.
- You say “YES” way more than you say “NO” - The fewer reasons you have to say, “I’m sorry, I can’t accept this referral from you”, the more chance you have of them continuing to send business to you. If you have a lot of reasons to say no, you better be very good at what you do if you expect them to continue to send business to you.
Referral sources (hopefully) realize that you likely don’t offer every brand or product line in every single equipment category, and that you may not be a participating/in-network provider for every single health plan out there. For those reasons, on occasion, they should anticipate that you may have to turn down a referral if the request is for something you don’t offer, or if the patient is insured by a health plan you don’t participate with, etc. But if that number of times they hear “NO” from you gets to be too frequent, you may be giving them a reason to go out and look for someone else who will say “YES” more often. Those of you who cover large geographic areas, offer nearly every product category, have multiple drivers on the road at all times with stocked vehicles, participate with virtually all insurance plans in your area, etc. have very few reasons to say “NO” to a referral source when they call. That makes it very easy for that referral source to continue sending business to you. I’m not saying every provider should start offering every product or open more locations, I just want you to be aware of who you are and who the other options are for that referral source. Ask yourself (honestly), if you were in their shoes, who would you refer your patients to?
Much like referral sources, payers also expect you to ideally say yes more often than no, as well as being responsive, timely, and reliable. But in addition to all of that, the payer relationship has some factors that come into play that aren’t present on the referral source side of things, namely:
- Reimbursement rates
- Reimbursement timeframes (outstanding A/R)
- Claims denials/appeals
- Patient billing (for deductible/co-insurance)
In most cases, you’ll find the payers want you to do all of these things really well, and they want to pay you as little as possible for doing it. And even if you do all of it well AND agree to their reimbursement schedule, they still might not offer you a contract, telling you their network is full (narrow or closed networks…again, a whole other topic for another day). When it comes to contracting with payer sources, here are some of the most important things to keep top of mind:
- Make it about them – find out what their pain points are (ask them), and let them know how you can alleviate those pain points
- Show value - In all cases, and especially in the narrow or closed network scenario, make sure you are able to articulate the value your company will bring to the health plan and their members. If you can’t tell them why they need you, they aren’t going to need you.
- Make sure expectations are clearly outlined and understood, from both sides. - If you get to the point of a contract offer, the contract language will have been written by them and for them. All of their wishes and expectations will be spelled out there, but they didn’t have any input from you when it was drafted. Don’t hesitate to outline your wishes and expectations and incorporate them into your contract as well. A guarantee of payment within a reasonable timeframe for clean claims would be an example of something to ask for if it is not spelled out in the contract.
- Communication – Make sure they have a point of contact within your organization, and that you have one from within theirs. When questions or issues arise from either end, it’s important that they can be addressed quickly. Having good contacts is very important for that. And don’t be afraid to communicate with them periodically even when there isn’t an issue or a question. Just check in with them from time to time.
If you are focused on and are very good at meeting the things outlined above, you should achieve very high customer satisfaction and will have very happy payers and referral sources who will continue to refer their patients to you.
Craig Douglas is the Vice President of Payer and Member Relations for VGM & Associates.
LinkedIn: Craig Douglas
- billing & reimbursement
- business solution