Healthcare Fee Schedule Analysis

One of the growing trends in healthcare is patients “shopping” for services rather than going immediately to their PCP. This means healthcare offices have a driving need to be competitive. Clinics can accomplish this by providing new options for personalizing the customer experience. More clinics have been adapting to this by providing a broader range of collection, contract management, and billing options. However, this has been complicated by a growing trend of providers experiencing unexpected reductions in reimbursement. Every year, thousands of clinics are underperforming due not understanding their reimbursement for services provided and optimizing.

Establishing & Maintaining Your Fee Schedule And How It Helps Your Practice

These unexpected changes often involve payors suddenly adjusting their rates without informing the provider.  Establishing a fee schedule is essential to this process. Analyzing reimbursement rates based on services provided makes it possible to identify where these reductions are hitting you. 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:

  • Acquire current Payor rates
  • Analyze Payor Contracts
  • Analyze Payor Reimbursement
  • Analyze Payor Distribution (Payor Mix)
  • Complete Gross Charge Analysis to ensure maximum reimbursement
  • Break Even Analysis, what does it cost to provide the service?
  • Analyze Financial Impact, where applicable

It’s difficult to overstate the importance of the fee schedule for your business. You will be able to give patients clear financial expectations at time of service and beyond.

Call Today to Maximize Revenue

Schedule a consultation with our team, this service can enhance revenue. 

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