When there is no applicable fee schedule or a facility is exempt from the fee schedule, IMS will determine if there is a PPO contract or an IMS agreement that applies to the charges. If not, IMS’ facility review experts conduct three usual and customary reviews based on the services performed, the hospitals geographic location, and the hospitals credentials. IMS’ experts then use the median usual and customary allowance as leverage during our negotiation. In addition, as a software development company, IMS built a specialized database that stores data on exempt hospitals that include:
- Usual and customary charges and allowances
- Notes on prior negotiations
- Contacts and personnel
- Previous accepted payments
Most companies charge a higher fee for negotiation services than IMS due to the need to access “out of network” databases. They are at the mercy of these third party vendors and as a result, have no way of updating or controlling the quality of the data. IMS is proud of maintaining such information in house to provide the highest level of accuracy when negotiating with providers.
IMS takes pride in having the capability to provide custom networks for our clients. The ability to customize a PPO network that meets the individual needs of the employer is very powerful. This tool is extremely valuable when a respective hospital may not be in a national PPO network. Many networks will create mosaic networks comprised of many smaller networks covering numerous lines of insurance. This can actually have a negative effect as they often contain bad contract data, or contracts that pay more than the normal usual and customary workers’ compensation rate or even dictate that the bill must be paid in full at the hospitals usual and customary billed charges. Our partners are able to create custom networks based on the needs of the employer. This is especially helpful in states where fee schedules may not exist.
Upon completing negotiation, IMS always secures a signed agreement. This can include the supplied Form of Settlement Agreement. IMS would negotiate in good faith to ensure that the provider completes and signs the proposed agreement to ensure payment. Before any agreement is sent to provider for signature, our negotiation staff will confirm that both parties accept the agreed upon negotiations. It is common for our negotiating team to provide incentives to get a reduced settlement by working with IMS on a quick pay option if available. IMS also has our own “Settlement & Release Agreement for payment of Medical Services” when assistance is needed on setting up a new program
In addition, when IMS administers PPO Discounts for the employer, these are contractual agreements between the network and the provider. Thus ensuring prompt and undisputed payments.