Quickly Increase Revenue Through Strategic Fee Schedule Analysis

Feeling the squeeze from payors? You’re not alone. 

Ever feel like your practice is doing more but getting paid less? You’re not imagining it. Operating costs continue to rise while reimbursement rates stagnate or decline. It’s easy to attribute financial strain to external factors, but many practices miss one important factor that can make a measurable impact: contracted reimbursement rate (fee schedule). 

Fee schedule may not be the flashiest part of your operations, but what seems like a minor administrative detail is a powerful lever for improving reimbursement outcomes. 

The Hidden Cost of Inattention 

Here’s the uncomfortable truth: most payor contracts with original fee schedules are out of date. Practices secure payor contracts during practice startup with the payor often issuing below market reimbursement rates out of the gate.  Then the practice does not revisit their contracts after the initial contract term. However, payor contracted reimbursement rates remain stagnant or shift over time and drift out of alignment with actual service costs. 

Maybe your reimbursement rates have quietly dropped unbeknownst to you, your top-billed codes haven’t been reviewed in years, or your charges are still based on what seemed reasonable five years ago without any adjustment for new payor reimbursement behavior or the increased cost of care. 

This kind of inattention adds up—slowly, silently. Even a 5-10% discrepancy across top-billed codes can add up to thousands in monthly lost revenue. A regular check-in with your fee schedule can uncover issues you didn’t even know you had. 

What an Effective Analysis Looks Like 

So, what does a comprehensive master fee schedule analysis look like? It’s not as intimidating as it sounds. It is more than reviewing a spreadsheet. The analysis answers the questions: Who is my poorest payor? What is my payor mix? Are charges capturing maximum reimbursement? How does payor reimbursement stack up against each other?  One of the key benefits of the analysis is that it reveals where your charges may be underpriced, outdated, or misaligned with reimbursement realities.  

Here’s what it typically involves: 

• Pulling all codes utilize for the past 2 years 

• Benchmarking those codes against charges Medicare, commercial, and regional reimbursement 

• Cross-referencing your contracts to see how much each payor reimburses per code 

• Identifying patterns of unusually low rates or underpayment 

• Flagging outdated CPT codes for adjustment 

If that sounds overwhelming, don’t worry—plenty of tools and our consultants can walk you through it. The important part is starting. 

Using the Data to Your Advantage 

Once you’ve identified the gaps, you can start making informed decisions. If your fees are too low compared to benchmarks, adjust them—strategically.  

More importantly, this data arms you for navigating payor contract negotiations. With solid analysis, you can approach payors from a position of strength. Instead of a vague request for better rates, you can present evidence: Here’s what it costs us to provide care, how payor’s reimbursement compare in our market, and validate what we’re asking for. That’s a much stronger conversation than hoping for better rates without backing it up.  

Negotiations don’t always move fast, but they’re more successful when backed by data. Payors respect practices that understand their numbers and know what to ask for. 

Making It Routine 

One of the biggest mistakes practices make is treating reimbursement management like a one-time event. It’s not. It’s an ongoing process that should be baked into your annual revenue cycle—ideally, alongside budgeting, payor contract reviews, and coding audits. 

Here’s how to keep it manageable: 

• Assign ownership—someone on your leadership or billing team should oversee the fee schedule. 

• Review at least semi-annually—or more often if you’re making major operational changes. 

• Involve the right people—consulting with an outside expert can help ensure you’re benchmarking against accurate data and using the right strategy. 

When to Bring in a Healthcare Business Consultant 

Specialized insight drives strategic results. 

Engaging a healthcare business consultant is a strategic move when internal resources are limited or when reimbursement challenges persist. Our experts offer data analytics, industry benchmarking, payor contract negotiation experience, and targeted revenue optimization strategies. 

We identify gaps in your fee schedule and help you design and execute a plan to correct them. From custom fee schedule modeling to payor negotiations, our advisor turns complexity into clarity and missed revenue into recovered profit. 

Make Your Fee Schedule Work for You 

Payor reimbursements may not be entirely within your control, but how you manage your payor reimbursement is. With the right process, data, and support, your practice can start optimizing reimbursement rates and reclaiming the revenue it earns.  

Now is the time to move from passive oversight to proactive management. At Complete Healthcare Business Consulting, we bring over 30 years of healthcare expertise to help organizations align their fee structures, optimize reimbursements, and strengthen their position at the negotiating table. 

Ready to maximize reimbursement and build a strategy for payor contract and reimbursement management? Contact us today to schedule a consultation with our team.