Medical billing and revenue cycle management
There is no renewal event. Nothing arrives in the mail. The only signal is a margin that slowly gets worse and gets blamed on costs. Commercial professional rates now average 148 percent of Medicare. A contract nobody has opened captured none of that.
Twenty minutes. If your rates are already where they should be, we will tell you that.
Open Availity, go to Claims and Payments, then Fee Schedule Listing, and pull your contracted rate for your top five codes. Then look the same codes up on the CMS fee schedule at your own locality, not National. Divide one by the other.
The basics, since you will check anyway
Each one leaves your reports looking healthy.
The visit happened and the note exists. The charge was never built, so nothing was submitted and nothing came back denied.
The claim went out correctly and came back paid, at a level below what the documentation supports.
The payer's own fee schedule says one number and the remittance says another. Nobody reconciles the two.
A client kept running long on follow-up visits. The schedule said one thing, the claim numbers said another, and the two never lined up. Our team asked about the gap.
The practice had been providing a service they did not know was covered. It was documented in the notes every time. It had never been submitted. We filed retroactively and it kept paying going forward. The level of care they wanted to provide stopped being a time cost, and growth became an option.
Step one
You check it yourself. The self-check above takes one report and about ten minutes. You do not need us for that part and you do not have to tell us what you found.
Step two
Twenty minutes on the phone. You tell us what you found and what you run on. We tell you what we would expect to find underneath it and what it takes to fix.
Step three
If you move, payer contract renegotiation is part of onboarding, at no separate fee. Rates set back when the practice was smaller are usually the second thing we find.
Every one of these is answerable from documents you already have. Almost no owner can answer them from memory, and nothing in your billing system surfaces any of them.
What percentage of Medicare are you paid for your top five codes?
For one payer and one code, are all of your allowed amounts the same number?
What date this year is your last day to give notice on your largest commercial contract?
When did any of your rates last go up because somebody asked?
Do you hold a direct contract with every entity that has taken a network discount off your remittances?
Which of your contracts lets the payer change terms if you do not object in writing?
If you can answer all six, your billing is in better shape than most practices and you probably do not need us. If you cannot answer four of them, that is not a competence problem. No report in your system was ever built to show you these numbers.