Making Payer Analysis A Priority

Accepting payer contracts and fee schedules as the status quo is one of the most common reasons why practices struggle to remain profitable. Physicians run the risk of being reimbursed from an outdated payer fee schedule without a focused strategy to analyze payer contracts and reimbursements. You must put a strategic plan in place.

Why is it important to analyze payer reimbursement today in a predominantly fee-for-service world?

Analyzing payer reimbursement ensures practices are paid correctly for services they provide. Practices that take the time to analyze their payer contracts and reimbursements find that payers become more communicative and open to negotiations. The payer now understands that you have a focus and strategy for running your medical practice like the business that it is.

Analyzing Payer Reimbursements

Review the practice’s reimbursements by code and per payer. Ask these questions: What should the practice have been paid according to its payer contract? What was the practice actually paid? Is there a discrepancy? If so, why?

Practices may find it helpful to purchase contract management software to analyze their payer contracts and fee schedules more easily. The CodeToolz Contract Analyzer was built specifically for this purpose.

Analytics allows healthcare providers to understand the true value of their payer contracts. With the CodeToolz Contract Analyzer, physicians have the ability to visualize their existing contracts and how commercial payers stack up against each other.

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 any medical practice.

Fortunately, longstanding patterns of poor attention to contracts can be broken by managing, analyzing, renegotiating and monitoring your payer contracts. We believe in a proactive approach, not a reactive one.

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