Insurance Contract Evaluation | Physician Practice Specialists
insurance contract evaluation

Insurance Contract Evaluation

Evaluating your Payer Fee Schedules

Here is a video tutorial on how we go about evaluating proposed rates as part of our renegotiation service. This evaluation can be conducted at any time to analyze the various payers you’re contracted with and how their various fee schedules are affecting your revenue.  Evaluating your insurance contracts is important to the health of your practice whether you plan to negotiate your fee schedules or not.

What is your benchmark fee schedule?

One of the first steps in evaluating your contracts is to determine your baseline fee schedule.  You have to have something to measure all of your contracts against.  We prefer to measure all agreements against either current year or the most recent Medicare fee schedule. We then can measure all commercial insurance fee schedules against it to discover opportunities and best performers.

What else should I look at?

In addition to the rates, remember to pay close attention to the terms and conditions of the contract.  You want to ensure that no matter how good the fee schedule is, the agreement you’re signig still makes sense for your business.  If you know you’re getting ready to expand, do you really think it’s best to commit to a 5 year agreement?  How about timely filing, claims processing guidelines, balance billing, termination provisions, how fee schedule changes are handled, credentialing timelines, etc…  Once the agreement is signed, all negotiating goes out the window.

Sorry about the loud noise near the end of the video. We had a crazy storm blow over our office as I was finishing the video.