One of the growing trends in healthcare is patients “shopping” for services. This means practices have an increasing need to know the contracted rates with payors. Practices can accomplish this by securing payor fee schedules at least annually. Providing the cost for service at the time of service personalizing the customer experience. This also enhances collections, reduces accounts receivable, and minimizes billing efforts. The No Surprise Act established in 2021, requires all healthcare entities to provide an estimate for services at least 4 days in advance for no covered services, out of network providers, or patient with no insurance.
Providers are also experiencing unexpected reductions in reimbursement, so knowing previous reimbursement and comparing current reimbursement based on service units will show any reductions. This enables practices to reach out to payors immediately and dispute. Every year, thousands of practices are losing revenue due to not knowing their reimbursement for services provided, changes in reimbursement and the financial impact, and optimizing their gross charges to capture contracted rates.
Complete Healthcare Business Consulting (CHCBC) offers personalized consultations and data-driven insights to help you confidently capture all revenue and maximize profitability.
Your practice can stay ahead in the healthcare industry by establishing and maintaining a comprehensive fee schedule. An analysis from CHCBC identifies hidden revenue opportunities and ensures you’re maximizing reimbursements. Then, with clear financial expectations for patients and improved leverage with payors, you can enhance revenue and drive growth for your practice. CHCBC provides expert fee schedule analysis and consultation services, leveraging our industry expertise to tailor solutions that optimize your revenue potential.
The tailored analysis from CHCBC equips you with insights into payor contracts, reimbursement rates, and cost structures, empowering you to navigate financial complexities confidently. Don’t let uncaptured revenue slip through the cracks—schedule a consultation with CHCBC today to safeguard your practice’s financial health.
CHCBC offers over 35 years of expertise in assisting on the business side of healthcare. Led by Jackie Coult, CHCBC provides personalized solutions tailored to individual practice needs. From master fee schedule analysis, revenue cycle management practice formations to mergers/acquisitions to compliance, CHCBC assists practices in maximizing profitability, efficiency, enabling practices to maintain quality of care.
Establishing and regularly updating a fee schedule is crucial for healthcare providers due to the unexpected reductions in reimbursement and the growing trend of patients “shopping” for services. A fee schedule provides a clear framework for setting gross charges to maximize reimbursement. You’ve earned it, let’s ensure you capture it.
A comprehensive fee schedule analysis from CHCBC involves acquiring current service utilization, payor reimbursement, analyzing payor contracts, and assessing payor distribution (payor mix). This analysis allows healthcare practices to identify unexpected reductions in reimbursement and understand their financial impact. By having a clear picture of where reductions are occurring, providers can create leverage with payors during negotiations.
A fee schedule analysis involves several key steps, including acquiring current payor rates, analyzing payor contracts, assessing payor reimbursement and distribution, conducting a gross charge analysis, performing break-even analysis, and evaluating the financial impact. The analysis helps in maximizing reimbursement, identifying cost-effective service provision, and ensuring that the practice remains financially sustainable. By continually evaluating and updating the fee schedule, healthcare practices can proactively manage their finances, adapt to industry changes, and provide better financial clarity to their patients.
Stay Competitive and Give Patients Clear Financial Expectations
Analyzing reimbursement rates based on services provided makes it possible to identify where reductions are hitting your practice. This information can help create leverage with your payors while setting reimbursement rates and gross charges that keep you competitive. Additionally, during a fee schedule analysis, we may be able to identify funds that were earned but not captured due to not continually evaluating your gross charges. This analysis also helps identify current services, poor payors, coding errors and what it costs to provide services.
A comprehensive fee schedule analysis involves the following steps:
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