Insurance Contract Analysis

It is our goal to ensure physicians and providers across the country have an accurate understanding of how they are being paid for their services. All too often, we find businesses surprised when they learn they are only being paid 75-80% of current year Medicare. The costs of doing business go up every year and it is critical that your revenue goes up with it. Unfortunately, this is not the case for most physicians in this country. You cannot afford to leave it to the insurers to pay you what they can get away with. With the push towards Value Based Medicine and the resurgence of capitated contracting, it is imperative that you have a solid grasp of how you are being compensated. Being informed usually means finding opportunities to improve your current situation. If you are a top performer and still independent, you can be sure that insurance companies want to keep you happy and out of the hospital system. Because of this, independent practitioners have more leverage to negotiate better rates.

Our contract evaluation service will provide the insight and analysis necessary to effectively negotiate your contracts. Regardless of who does it, a thorough evaluation is critical if you hope to capture every last dollar owed to you.

1. We spend 1-2 hours carefully reading and taking notes on each contract.
2. Carefully critique and analyze the most important terms of the contract and provide these terms in our summary report.
3. We will use the revenue by CPT code report to conduct a comparative analysis of your rates vs current year Medicare.
4. We summarize our findings with the fee schedule evaluation in an easy to read document.
5. Prepare an Action Plan that will act as a road map for our negotiations