Regional Ophthalmology Practice
10.8%
Weighted average rate increase across multiple major payors
$628K+
Delivered annualized revenue increases
About the Client
A multi-location ophthalmology group serving patients across a largely rural region of the southeastern United States. The organization is recognized for its leadership in advanced eye care procedures and its commitment to improving access to specialty services in both urban and underserved areas.
Client Needs
The client engaged PayrHealth to strengthen payor relationships and improve reimbursement rates that had not been updated in several years. Their challenges included:
- Outdated Reimbursement Rates: Existing contracts no longer reflected the complexity or value of their specialty services.
- Coverage Gaps: High-value ophthalmologic procedures such as corneal and retina transplants were inconsistently covered across major payors.
They sought a contracting partner capable of securing meaningful rate increases, expanding payor participation, and demonstrating their clinical and community value through data-driven storytelling.
86K+ Unlocked access to new covered lives.
PayrHealth’s Solution
Comprehensive Contract Strategy
PayrHealth developed a strategic contracting plan focused on achieving higher reimbursement, expanding payor access, and advocating for coverage of previously excluded procedures.
Data-Backed Negotiations
Leveraging payor data, regional cost comparisons, and patient access insights, PayrHealth positioned the practice as an essential access point for specialty eye care, particularly in underserved communities. This evidence-based approach provided payors with a clear picture of the client’s cost efficiency and clinical quality.
Secured coverage for previously excluded ophthalmologic procedures.
