“We were fortunate enough to work with HBN when FeeMaster was being developed. We’ve been using the payer analyzer tool for several years now to determine whether payer offer rates are appropriate… and when they are not, we use FeeMaster to develop counteroffers that are acceptable. With the ever- growing uninsured population we also use FeeMaster’s chargemaster tool to create the baseline for consistent prompt payment discounts. FeeMaster has been invaluable in developing and achieving our group’s financial goals. Can’t say enough about the staff at HBN and the insight they provide us in the contracting process.”
Jerome I. Silver, M.D.
Partner, Roswell Radiology Associates
Tools for Analyzing Payer Contracts
“Preparing for reimbursement models that place a greater share of financial risk on the practice” ranks #1 in recent MGMA Medical Practice: What Members Have to Say Survey
In a 2011 research questionnaire MGMA asked members which challenges were most applicable to their daily lives. The top extreme challenge was “Preparing for Reimbursement Models that Place a Greater Share of Financial Risk on the Practice.” “Negotiating Contracts with Payers” also ranked in the top 10 extreme challenges for practices.
More than a decade before this study, Health Business Navigators created FeeMaster to address these very important practice issues related to negotiations with payer contracts.
HBN puts at your fingertips a tool, tailored to your practice, that calculates instantaneously the potential financial impact of nearly any contract fee schedule offer or proposed payer rate amendment.
Health Business Navigators’ founder, Penny Noyes, spent 18 years on the payer side of the industry, responsible for hundreds of thousands of provider contracts nationwide. During the mid-to-late 1990’s she switched to the provider side and spent 5 years in practice management, handling the acquisitions, revenue improvement, and payer and network contracting for nearly 100 health centers in 7 states. In 1999, she founded HBN with the goal of providing consulting services to physicians to create an even playing field at the negotiating table between payer and provider. Today HBN’s expert staff works with clients across the country to improve contracts with payers. The design of FeeMaster is regularly updated for ease of use and to address the ever-changing needs and methodologies in the contract negotiation processes. Special FeeMaster models address the unique reimbursement methodologies for physician practices, ASCs, anesthesiology, and other services.
When you order FeeMaster™
You decide which payer and network contracts you want to analyze. HBN staff works with you to determine all of your contracted rate schedules and to pull well-defined data from your practice management system for each contract you want to analyze or renegotiate.
HBN loads your data into your FeeMaster tool, which is pre-populated with formulas and publicly available data, enabling your tool to test an infinite number of payer offers and your counter-offers to determine what various reimbursement rates will do to your bottom line, in aggregate and by CPT®. It even has a feature that allows you to export your data to a special tool to analyze proprietary schedules of payers .
An HBN contracting specialist sends you your FeeMaster tool and walks you through it in a demo lasting up to one hour. They show you the glaring issues the tool can expose about your contracts and chargemaster and answer any questions you might have.
Don't be intimidated by the analysis and lengthy agreements. Let HBN import your data into a tool that empowers you to tackle your next negotiation with confidence, see your contract rates in a payer line-up, test the adequacy of your charges, determine which procedures to "carve out" of the standard schedule, and more. Put our decades of payer experience to work for your practice.
Actual Results
A six-physician hospital-based group used FeeMaster over a five-year period with HBN’s negotiation assistance and experienced a verifiable impact of nearly $2 million annually to the bottom line related to just 4 payers that were previously contracted at terribly low rates. They use the Chargemaster evaluation tool to test and modify charges and set parameters for their uninsured prompt payment program. And they continue to use their Line-Up to compare rates from payer to payer.
A five-physician pediatric group was unsure how a rate amendment changing their rate schedule’s Medicare year conversion factor basis from 2011 to 2010 would affect 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.
A large multi-specialty group was overwhelmed by the daunting task of re-negotiating its many aging, complicated payer agreements. With HBN’s experts on task, the existing contracts and rates were gathered, data from the practice management system extracted. HBN tailored their FeeMaster by creating specialty categories defined by procedure code ranges consistent with the practice specialty departments, allowing the practice to negotiate higher rates on their services that were unique to the geographic area and settle only for those services for which there was excess capacity in the market or were available for patient convenience and compliance (such as lab). With the contract rates negotiated, the practice was able to load the new rates in the billing system.
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 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 before the rates had been amended through a notice that 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 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.
