Who is Responsible for What?

Doctors, we would like you to think about your payer contracts as you do your patients. It is a team effort, the more responsibility taken, the better the outcome.

We need certain information from you that will allow us to provide you the expert services you paid for. Some of this information you may not have, if you do not, we provide you with payer letters to request it.

The timeline for completion of your Contract Analyzer will depend on how fast you can get this information.

Folders and Files

We request that you create a “CodeToolz” folder on your desktop. In that folder, you’ll have, 2 Excel files, “Codes and Charges” and your “Contract Analyzer”.

In that Codes and Charges file you’ll see 2 worksheets: Codes and Charges (what you’ll send us) and Payers (filled out by you). We’ll keep this as a running Excel file with the same name.

Also, in your CodeToolz folder, you’ll have 5 Word documents: Payer Letters.

Please, look at the “body” of each; complete the () where you can (i.e. (x) years of service to (City) and the surrounding communities) in the Requesting a Fee Schedule Increase letter. Save those as is in your CodeToolz folder.

Within your CodeToolz folder, you’ll want payer folders. When you send one of your templated letters to any payer, the letter can be saved specific to and in that payer folder, keeping the template intact for future use.

Physician’s Codes and Charges

This is no problem at all, we request them from you in Excel format and customize your Contract Analyzer for you.

Payer Contract – Do You Have It?

No – we provide you with a letter to request it from your payer. This is on your letterhead with your Tax ID and NPI.

Note: all documents should and must be signed by the physician.

Yes – you need just a handful of data items from your contract:

  1. Payer Name
  2. Original Effective Date
  3. Term (Years)
  4. Tied to Anniversary (Y/N)
  5. Termination Notice (Days)
  6. Payer Rep. Info

The above items (2-5) can be found in the Term & Termination section of your contract. Fill these in on the “Payers” worksheet of your “Codes and Charges” Excel file.

Payer Fee Schedule – Do You Have It?

No – we provide you with a letter to request it from your payer. This is on your letterhead with your Tax ID and NPI.

Yes – if the reimbursement methodology of the payer fee schedule is a certain % and Year of Medicare, no problem, we have that data.

If the payer fee schedule is not a % of Medicare, it is the payer’s own methodology. Ultimately this payer fee schedule must be in Excel format for your Contract Analyzer.

Note: Your payer fee schedule can come in many formats. You can login to a payer portal to view the schedule, you can receive it as a pdf file, you can receive it as a fax, etc. We may be able to convert the payer fee schedule into Excel for you (depending on the current format) but we can not log into any payer portal to retrieve it. This can easily be done by your office manager.

Summary

As the old saying goes:

If you give a man a fish, you feed him for a day. But if you give him a fishing rod, you feed him for a lifetime.

Pardon the gender-incorrectness, we didn’t coin it.

Our Fishing Rod (Contract Analyzer)

Once complete, you will have a turn-key solution for your payer contracting needs. All contracts, fee schedules and necessary documentation to maximize the revenue you work so hard for.

Just one example (there are many). When is the last time you renegotiated a payer contract based on the renewal date? Ever?

Not only will you be accomplishing that now, you’ll be achieving it every year forward – the way it should be.

Payer Negotiation Considerations and Checklist