Many providers erroneously believe that payers have an overwhelming advantage in fee schedule negotiations. Actually, providers have greater access to relevant data, but often lack the resources needed to translate those data into valuable negotiation information. Payer Fee Schedule and Margin Analysis allows the comparison of reimbursement rates to actual service production costs for the unique mix of services provided to a payer’s beneficiaries— thereby determining the specific margin attributable to a payer’s business. MBA is experienced in supporting empirically-substantiated rate negotiations and successful in gaining justified adjustments.

A medical group was dissatisfied with prevailing collections, but uncertain about which payers or services were responsible for the unsatisfactory performance. MBA determined the group’s production costs and margins by procedure and by payer. Empowered by the knowledge of their actual costs and margins, the group developed reasonable rate adjustment requests that were readily approved by the payers.