Your contract rate sets the ceiling on every claim
Good billing is about getting paid more for each visit. A better contract with your largest insurers can make as big a difference as solving your eligibility problems. Atlas helps you renegotiate your payer contract to top-of-market rates.
Let's TalkRate increases negotiated with
From contract review to collected dollars
What we look for in your contracts
The rate on page one is rarely the whole story. These are the terms that decide what you actually get paid.
- Rate basis
- Many contracts pay a percentage of Medicare, pinned to a specific year. If your contract references an old Medicare fee schedule, your rates stay put when Medicare updates. Others use a proprietary payer schedule the payer can revise.
- Escalators
- Some contracts raise rates each year. Many have no increase at all, so inflation lowers your real rate every year the contract renews.
- Lesser-of-charges
- Most contracts pay the lower of your billed charge or the contract rate. If any of your charges sit below a contracted rate, you are paid the lower number. We check your charge master against every fee schedule.
- All-products clauses
- Some contracts require you to accept every plan the payer offers, including Medicare Advantage and Medicaid managed care lines that pay less. These can be negotiated separately or carved out.
- Unilateral amendments
- Many contracts let the payer change the fee schedule with written notice. Those notices are easy to miss. We track them so a rate cut gets caught when it arrives.
- Renewal and notice windows
- Auto-renewing contracts usually have a set window to request changes before the anniversary date. Miss it and the current rates roll forward another term.
- Codes missing from the fee schedule
- New codes, add-on codes, and codes you started billing after you signed often pay a low default rate. We compare what you bill today to what the contract lists.
- Timely filing and appeal limits
- Short filing and appeal deadlines turn small delays into write-offs. These terms are negotiable along with the rates.
What payers respond to
A payer raises rates when it sees a cost to saying no. Early on, we sit down with you to understand your practice’s unique value, then craft the story we take to each payer and back it with this evidence.
Market rate data
Federal price transparency rules require health plans to publish their negotiated in-network rates. We use that data to show a payer what it pays comparable practices in your area.
The members you serve
Your patient volume with that payer, your share of its members in your area, and how many of its members would need a new provider if you left the network.
Access the network needs
Specialties the payer is short on, appointment availability, locations, languages, after-hours care, and telehealth. Payers have to meet network adequacy standards, and access gaps are leverage.
Quality and total cost
Outcomes, patient experience, and lower total cost of care, such as fewer emergency visits or care delivered in a lower-cost setting.
What an increase is worth
Pick one payer. Enter what it pays you in a year and see what an increase adds over the life of the contract.
Added revenue per year
$50,000
Over the contract term
$150,000
Assumes the same visit volume and payer mix. This shows what a given increase is worth, not what a negotiation will produce.
A good time to negotiate
- Your contracts are more than two years old
- You have not reviewed your fee schedules since you signed
- You are adding providers, locations, or services
- One or two payers make up most of your revenue
- You see a lot of commercial or managed care patients
- You are in a specialty like behavioral health, psychiatry, or orthopedics