Payer Contracts and Fee Schedules Blog

We discuss common issues that healthcare professionals encounter in their payer contracts and suggest ways you can improve your contract and fee schedule issues.

While working with healthcare groups across the country, we have seen payers reduce their fee schedules by 5% to 12% due to lack of attention, this is devastating to your practice.

The purpose of the CodeToolz Payer Contracts and Fee Schedules blog is to provide physicians with information to help them make sense of the growing complexity of payer contracts and gain leverage when negotiating with payers. We believe in a proactive approach, not a reactive one.

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This bill expands restrictions on charging health care plan holders out-of-network rates for certain services.

H.R. 3630 | No Surprises Act Effective Date (1/1/2022)

This bill expands restrictions on charging health care plan holders out-of-network rates for certain services. First, the bill requires insurers offering plans that cover emergency services to bill plan holders

On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) published the 2022 Medicare Physician Fee Schedule Proposed Rule.

2022 Medicare PFS Proposed Rule Top 10 Takeaways

On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) published the 2022 Medicare Physician Fee Schedule Proposed Rule. The 1,747-page document covers topics such as telehealth services

Medical practices that leave money “on the table” as a result of billing inefficiencies should correct these inefficiencies and now.

The “Lesser Of Billed Charges” Clause In Payer Contracts

Medical practices that leave money “on the table” as a result of billing inefficiencies should correct these inefficiencies and now. One of the most common operational language clauses in payer

Physicians are often paid based off payer fee schedules. These fee schedules define how much a doctor will be paid for performing a service. In general, there are typically three types of fee schedules: Medicare, Medicaid, and Commercial.

What Is The Insurer Paying The Doctor And How Is It Decided?

Physicians are often paid based off payer fee schedules. These fee schedules define how much a doctor will be paid for performing a service. In general, there are typically three types

To ensure adequate coverage of their enrollees, managed care plans frequently reach out to physicians to join their networks. Because so many patients are enrolled in managed care plans, physicians might assume that by not contracting, their practice will exclude many potential patients. The decision should be based on sound business strategy.

How Important Is This Payer Contract To Your Practice?

To ensure adequate coverage of their enrollees, managed care plans frequently reach out to physicians to join their networks. Because so many patients are enrolled in managed care plans, physicians

Benchmark rates for all your CPT® codes, by payer (individual code and in aggregate) to Medicare PFS Locality Rates and to the rates of other payers in the region. Compare your reimbursements on an ongoing basis; test the adequacy of your charges and much more.

The Provider Contracting System Designed To Enable More Profit

KEY FEATURES Reimbursement Rate Analysis Benchmark rates for all your CPT® codes, by payer (individual code and in aggregate) to Medicare PFS Locality Rates and to the rates of other