Payer Contracting and Fee Schedules

Optimize Your Practice’s Revenue

Calculate the financial impact of any contract fee schedule or proposed payer rate amendment for all your CPT® codes.

Quickly decide whether to accept or renegotiate terms.

We work with you to determine all your contracted fee schedules for each contract you want to analyze or renegotiate. Timeline.

CodeToolz sends you your Contract Analyzer and walks you through a demo and answers any questions you might have.

Templated payer letters come with your Contract Analyzer to make the right move for your practice and revenue.

Without a sound contracting strategy any physician is at the mercy of any payer.

Put our decades of payer experience to work for 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 Contract Analyzer

(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.

See your contract rates in a payer line-up (matrix), identify carve-outs, test the adequacy of your charges and more.

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.

Favorable fee schedule adjustments have an immediate impact on your practice’s bottom line.

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

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.