Managed Care Contracting & Fee Schedules Made Easy

Featuring Our Physician Charge & Payer Analysis (PCPA) Tool

Readiness Is Everything

Payer contracts and fee schedules are very important financial tools utilized by any medical office. The importance of properly managing and analyzing these must not be overlooked.

CodeToolz services included with your Physician Charge and Payer Analysis (PCPA) Tool:

  • Contracts and fee schedules inventoried and catalogued for proper management.
  • Payer fee schedules set up for proper analysis and renegotiation.
  • Letters prepared to send to your payers to renegotiate payment terms.

We will accomplish all of this for you, customized specifically to your practice.

Get Organized

Be Proactive

When it comes to payer contracts and fee schedules, in its simplest terms; (1) Know what you have. (2) Know what you want. (3) Know how to get what you want.

Using our Physician Charge & Payer Analysis (PCPA) Tool

(1) Inventory, catalog and analyze your payer contracts and fee schedules, extremely easy to use.

(2) Perform what-if analysis based on your fee schedule and/or utilization review, straightforward.

(3) Templated payer letters and guidelines for success, mission accomplished.

“I belong to an IPA and/or have a billing company”, please read this.

Physician Revenue and Payer Contracts

Managed care contracting is an integral part of medicine for virtually all health care providers.

Not managing or accepting bad contracts will have a severe negative-impact on physician and group practice revenues.

Physicians – you will not find a more cost-effective tool to get a handle on your payer contracts and fee schedules.

Your Medical Practice as a Business

You must ensure that your prices and contract payment terms are adequate to cover the cost to provide services and remain profitable.

Managed care dollars represent a significant percentage of a healthcare organization’s revenue.

We are experts at analyzing contracts and fee schedules, securing the most optimal payer fee schedules.

When is the last time you renegotiated your reimbursements? This can and must be done.

The last quarter of the year is the signal to start evaluating the past year and planning for the coming one. There are alot of things that impact your bottom-line, this is a critical one.

An evergreen clause, or automatic renewal provision, is a key term in many payer contracts. Often, practices just let contracts renew year after year without reviewing them.

The problem is that practices change: new services are added; costs increase and the size of the patient panel grows. This is especially important for small practices that already have low reimbursement rates.

You CAN Negotiate a Payer Contract

Many physicians assume that attempting to negotiate a payer contract is hopeless – but that is just not true.

The types of difficulties that physicians and their practices experience with payer contracting can be anything from contract negotiations to unannounced changes (amendments).

Some considerations (but not limited to):

  • Do the payer allowables cover your true costs of doing business?
  • How are the allowables calculated and the implications for the services you provide?
  • Is the contract crucial to your payer mix?

Only after you have a clear picture of how the contract will affect your practice as a business can you negotiate/renegotiate effectively, to get the terms and fees you need to remain profitable.

We Understand – We Promise

Most providers can probably share “war stories” over frustrating experiences they’ve had with a payers’ contract negotiations and reimbursements.

Physicians struggle with cash flow, hoping to get paid properly and in a timely manner while payers post multi-billion-dollar profits.

It does not have to be this way.

We have heard just about every war story you can think of (knowing there are more to come).

You study and work hard to help patients; we study and work hard to help you.

Contact us today (877) 464-3005, or schedule a demo and let’s get you started.