A five-physician pediatric group was unsure how a rate amendment changing a Medicare based conversion factor for their largest commercial payer’s commercial rate might impact their bottom line. Their FeeMaster’s RVU calculator determined that the new schedule would likely result in a $125,000 reduction in revenue over the next year. The practice objected to the amendment based on the contract terms, resulting in the payer’s retraction of the amendment and the preservation of the higher rates.

A large single-specialty group decided to evaluate and renegotiate all payer contracts. Using the FeeMaster Contract Line Up tool to compare all payer rates side by side, they discovered their best and worst rates for each code and weighted the analysis by utilization. They discovered one major payer’s rates were considerably less than they had negotiated 3 years earlier. Drilling down, they discovered that two years earlier the rates had been amended through a notice that contractually did not require delivery receipt or written consent. Empowered by this knowledge, they renegotiated with this payer and then each other payer in turn. To test payer-proposed rates and develop counter offers, they utilized the FeeMaster Analyzer tools to determine the dollar impact of the offers and counters that included % Medicare, carve-outs, banding, default formulas, and more. One renegotiation alone will improve revenue by $1.3 million over 3 years.

A large multi-location pediatric practice got 90 days notice that their IPA rates with their largest commercial payer were being slashed. This practice contacted HBN immediately knowing this notice was time sensitive and that the IPA would not be able to negotiate on their behalf, leaving the practice with the task of formally objecting to the lower rates per contract requirements, negotiating a direct agreement, and having to deal with direct credentialing as the IPA delegated credentialing would no longer apply. HBN reviewed the documents, assisted with the payer communication and negotiation, and created a FeeCreator for the practice’s adept analysis staff and management to utilize in testing offers and counters. By the effective date of the lower IPA rates, this practice had its own direct agreement in place, with credentialing underway, staving off a huge decrease to their bottom line.

A large multi-location pediatric practice was able to convince a payer that it was worthy of earning delegated credentialing to avoid the hassle of submitting credentialing apps for its many providers.  With HBN’s assistance, the practice created its credentialing policies and procedures that met the criteria of this and several other payers’ delegated credentialing programs. The bottom line — new providers could be credentialed and scheduled to see health plan members as much as 2 to 3 months sooner than going through traditional credentialing submissions with the payers.