For independent practices
See whether your contracts are below market.
Compare what each insurer pays other practices in your state for the codes you bill most, next to Medicare.
Example
99214 · Illinois
Primary-care practice
The practice finds that its 99214 rate with one insurer is 18% below that insurer's state median, and brings the comparison to its next contract discussion.
Start with
Your 10–20 highest-revenue codes.
The problem today
Insurers know what everyone is paid. You only know your own contract.
Renegotiation starts from a guess about what is fair.
Consultants who benchmark contracts are expensive for a small practice.
Medicare is public, but commercial rates have been impossible to compare.
How it works for you
Know your position before you negotiate.
01Pick the codes that make up most of your commercial revenue.
02Compare your rate with each insurer's median for your state and specialty.
03Take the gaps, with the insurer file date, into your next contract conversation.
Good to knowFigures are reference-grade. Confirm them against your own remittances and contract before you negotiate.