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In today’s evolving healthcare reimbursement environment, fee schedules are more than just line items on a spreadsheet—they’re the financial framework upon which your revenue cycle stands. Yet for many healthcare organizations, especially in complex specialties like oncology or durable medical equipment providers, fee schedule management is often inconsistent, incomplete, or entirely overlooked. Why? Because payors don’t make it easy.
At PayrHealth, we help providers transform fee schedule management from an ongoing pain point into a powerful revenue optimization strategy.
The Hidden Revenue Drain of Poor Fee Schedule Oversight
Fee schedules are notoriously difficult to manage. With dozens of payors, varying methodologies, inconsistent updates, and opaque exceptions, most providers understandably focus on their largest payors—often Medicare, Medicaid, and one or two commercial plans—and assume the remaining revenue is close enough. But here’s the reality: that neglected 20% could be costing you more than you realize.
Our data shows that oncology practices may be losing between $17,000 to $60,000 per provider, per month due to fee schedule inaccuracies, underpayments, and misapplied reductions. That’s not an operational inconvenience—that’s a serious revenue loss.
Payors benefit from this ambiguity. Practices often don’t have the time, tools, or internal resources to reconcile every line item. At PayrHealth, we level the playing field with a systematic, intelligent approach to fee schedule optimization—backed by real analytics and payer expertise.
Fee Schedules Should Be Your Revenue Cycle’s North Star
Effective revenue cycle management starts with clear expectations. Without a current, validated fee schedule strategy, your practice is flying blind.
PayrHealth helps you take control with:
- Comprehensive fee schedule audits
- Contract-to-claim payment verification
- Discrepancy identification and correction
- Mapping contracted rates to billing systems
- Underpayment recovery strategies
Our goal is to build a single source of truth around your expected reimbursement for a service—so you can hold payors accountable, track underpayments in real time, and forecast your revenue with confidence.
Where Most Practices Fall Short—and How PayrHealth Fills the Gap
Even a well-managed healthcare business can struggle with the nuances of fee schedule reconciliation. At PayrHealth, we help identify and correct common (but costly) issues, including:
- Incorrect application of APP reductions to non-E&M services
- Misalignment between loaded and contracted fee schedules
- Outdated mapping across multiple payors or locations
- Overlooked low-margin codes that add up over time
Too often, practices focus only on high-cost infusions or procedures. But we routinely uncover significant revenue losses on common services—like office visits, labs, or admin fees—due to misapplied payor logic or billing errors. Over time, these “small” errors snowball into six- and seven-figure losses.
PayrHealth’s Fee Schedule Optimization Approach
1. Audit and Analyze
We dive into your transaction-level data to compare actual payments with contracted rates. This allows us to identify where underpayments are occurring and why.
2. Define and Design
Using our proprietary methodology and historical match data, we build a logical, intelligent fee schedule model customized to your practice—one that aligns with payor-specific rules and reimbursement expectations.
3. Map and Monitor
We ensure your billing system fee schedules match your contracts and update them as payor policies evolve. This protects you from errors caused by system mismatches or unnoticed contract changes.
4. Train and Empower
Our experts educate your team on CPT- and NDC-driven schedules, locality-based rules, and documentation requirements—ensuring everyone from billing to finance understands how reimbursement should work.
5. Leverage Automation and Reporting
We deploy the right tools to reduce administrative burden, flag discrepancies in real time, and automate recurring tasks like fee schedule comparisons, payment variance reporting, and contract compliance checks.
What Makes PayrHealth Different?
Unlike generalized RCM vendors, PayrHealth combines deep expertise in payor contracting and credentialing with a tailored focus on fee schedule intelligence. We understand how reimbursement works—not just in theory, but in practice, at the line-item level.
We don’t just optimize fee schedules—we help physicians:
- Identify underperforming payors
- Understand crucial insights into customer billing
- Prioritize renegotiation targets
- Strengthen payer relationships
- Improve collections and reduce denials
- Accelerate revenue and reduce AR days
Fee schedule optimization is just one part of how we help clients build smarter, more predictable revenue cycles.
Stop the Bleeding, Recover Lost Revenue, and Strengthen Future Earnings
Think of your fee schedules as a contract blueprint. If your practice isn’t actively validating payments against contracted rates, payors are writing their own rules—and you’re likely footing the bill. The good news? It’s fixable. With PayrHealth as your partner, you can recover lost revenue, prevent future leakage, and finally have clarity and success in your revenue expectations. Let us help you transform fee schedule confusion into financial control.
Ready to unlock your practice’s full revenue potential? Contact PayrHealth today to schedule a fee schedule optimization assessment and see how much you could be leaving on the table.
