Maximizing reimbursement starts with mastering what many practices overlook — what you charge for services (Gross Charge Schedule or Fee Schedules) and payors contracted reimbursements by code and the services you provide.
It may seem like a back-office detail, but this can directly shape how much you get paid. When it’s outdated, underpriced, or out of sync with actual payor payment, you miss revenue you’ve already earned. And unlike a denied claim, these losses often go unnoticed — quietly compounding month after month.
That’s why regular Gross Charge Schedule or Fee Schedules reviews are a smart, strategic move and one of the most controllable ways to improve financial performance. But you must know all your payor reimbursement for all services provided to maximize your revenue.
Fee Schedules: The Foundation of Reimbursement Maximization
Every reimbursement dollar starts with your payor contracted reimbursement rate. Whether it’s Medicare, a major commercial payer, or a niche insurer, contracts are typically tied to less of your charge, their reimbursement schedule or a default rate (% of Gross Charge). If those charges are outdated or undervalued, you won’t get the reimbursement your services warrant. This is especially true for high-volume codes and procedures that form the core of your practice’s revenue.
For example, undercharging by just 5% on a procedure you perform 100 times a month could mean $6,000–$10,000 in lost revenue annually. Now multiply that across multiple codes, and the financial impact becomes hard to ignore.
Gross Charges below your max payor is causing significant hardship on practices. On the flip side, strategic updates to your payor reimbursement rates, creating a Master Fee Schedule based on all services (CPT Codes) utilize can identify poor payors and help to improve your to capture the max reimbursement you deserve. This also is essential in renegotiating contracts.
Over time, these small gaps turn into large revenue shortfalls — all because the starting point was off.
Aligning Fees With Payer Strategy
Your fee schedule plays a strategic role in payer negotiations. Pushing for higher reimbursement rates means your Gross Charge may need additional adjustment year-over-year. If Gross Charges are outdated or undervalued, your revenue suffers — not because of payer behavior but because of internal misalignment.
Why Alignment Matters
- Undervalued codes reduce reimbursement.
- Payers use your charges to reduce your payments — lower fees often mean lower allowed amounts.
- Contract credibility depends on current data
Practical Benefits of Regular Review
- Stronger contract leverage: Capture max reimbursement.
- More accurate estimates: Provide Patient clear financial expectations at the time of service. Preventing no surprise bills and building trust with patients.
- Internal consistency: Keeps collection ratio within industry standards and usual and customary rates.
At CHCBC, we often find that a modest, targeted fee adjustment—particularly for high-volume services—leads to measurable revenue gains. Implementing the maximization reimbursement approach isn’t just about negotiations. It’s about ensuring you are paid for all services you provide by all payors. Then you can start alignment with payor to actual cost of providing services.
Fueling Operational Efficiency and Full Reimbursement
Beyond revenue, clean and current fee schedules improve billing operations. They reduce underpayments, simplify patient estimates, and minimize confusion across coding and billing teams.
Here’s how:
- Clean claim submission: Stop manual pricing and only utilize one Gross Charge schedule.
- Patient responsibility estimates: Comply with the No Suprise Act.
- Coding accuracy: Coders spend can focus on coding versus inconsistencies.
- Front desk operations: Staff are left guessing what to quote — often quoting incorrectly.
Fee Schedule Review Importance: What Does a Review Look Like?
Practices that approach Gross Charge or Fee Schedule reviews as a regular, strategic function tend to increase revenue significantly — and fewer surprises. Here’s how to structure the process:
- Frequency: At least semi-annually, since payor reimbursement updates are scattered throught the year.
- Benchmarking: Compare your fees against Medicare, local competitors, and specialty-specific norms. Transparency data is a game changer in payor negotiations.
- Focus Areas: High-volume and high-revenue CPT codes, services with frequent payer pushback, or areas with recent changes in coverage.
- Collaborative input: Involve finance, billing, and clinical leadership to ensure charges make financial and operational sense.
- Tools: Use practice management software reports, industry data tools or bring in external consultants with market insight.
Done right, a fee schedule analysis is a direct investment in higher, cleaner, and faster reimbursement.
Regular Fee Schedule Updates: Turning Reviews into a Repeatable Process
Once a fee schedule review is done, the next challenge is making it a habit.
Here’s how to build it into your practice rhythm:
- Make it cyclical, not reactive: Set an annual or semiannual review cadence. Don’t wait for reimbursement problems to trigger it.
- Assign ownership: Make someone accountable — whether it’s your practice manager, finance lead, or an external consultant. Reviews don’t happen without clear responsibility.
- Document what changes and why: Keep a log of Charge adjustments and their rationale. This information is helpful for contract negotiations, staff training, and continuity.
- Integrate it into broader financial planning: Treat fee schedule alignment like a strategic budget line item — because that’s what it is.
When done consistently, fee schedule reviews become more than a revenue recovery tool — they become a foundational part of a stronger, more financially stable practice.
Start Prioritizing Your Fee Schedule Today
Too often, practices focus on growing volume or reducing costs to improve margins while overlooking Gross Charge or Fee Schedule alignments but can instantly improve revenue immediately. If your last Gross Charge or Fee Schedule review was over a year ago—or if you’re not sure when it happened—you’re likely undercharging. Undercharging in healthcare leads to under-reimbursement.
Maximizing revenue doesn’t always require new patients, more procedures, or new services. Sometimes, it’s as simple as ensuring you maximize revenue. Regular fee schedule reviews are proactive, measurable, and entirely within your control.
Ready to find out what your fee schedule might be costing you? At CHCBC, we specialize in uncovering overlooked revenue opportunities and payor negotiation opportunities. Contact us today to schedule a comprehensive Master Fee Schedule Analysis — and take the first step toward maximizing what your practice earns for the care you already deliver.
Maximizing Reimbursement with Fee Schedule Analysis FAQs
Gross Chares or Fee schedules set the baseline for reimbursement. Most payer contracts pay a percentage of your billed charges, so outdated or underpriced charges weaken your viability. Payers use your current charges to cap allowable payments. By aligning your Charges and secure all payors reimbursement schedules, you gain leverage, present a credible case for better rates, and avoid being reimbursed below charge. Strategic updates aren’t just administrative — they’re a core part of effective contract negotiation.
Outdated gross charges quietly reduce revenue. If your charges are below payer allowables, you’re underpaid — even when claims are “paid in full.” This often goes unnoticed and compounds over time. For high-volume services, even a 5% undercharge can mean thousands in annual lost revenue. These gaps add up fast. Regular reviews help ensure your fees stay current, competitive, and aligned with reimbursement opportunities — protecting the full value of your work.
Common mistakes include underpricing charge, skipping regular reviews, and failing to involve key team members like billing or finance. Many practices also forget to document changes, which complicates payer discussions and internal consistency. Another issue is not creating a Master Fee Schedule (inventory of all services and payor reimbursement rates) and treating it as a static document rather than a strategic tool. These oversights can lead to lost revenue, operational inefficiencies, and weaker contract leverage. Master Fee Schedules should be actively managed, not set and forgotten.
Use a mix of benchmarks: Medicare rates, local payor transparency data, and commercial payer allowables. Focus on high-volume Payors or CPT codes where small changes can have the biggest financial impact. The goal isn’t to charge the most — it’s to ensure you capture your contracted reimbursement. Benchmarking all payors’ reimbursement helps you charge confidently and negotiate from a stronger position.
Yes — especially if your team lacks the time, data, or expertise to do a thorough review. Consultants provide objective insight, sophisticated analytic tools, industry data, and strategic guidance. They can quickly increase revenue by identifying underpriced charges, coding errors, revenue cycle issues, support payer negotiations, and ensure your reimbursement reflects the true value and cost of your care. While internal collaboration is key, outside support adds clarity and structure. For many practices, it’s a smart investment with a fast return through improved reimbursement.
