One of the biggest frustrations I hear from independent practices is the black box of payer negotiations. We know it's an unfair and unbalanced playing field and the payors don't negotiate transparently or in good faith. The worst part? You have no idea if the fees you are paid for your services are good, bad, or somewhere in between.
Enter Paul Vanchiere (PMI, you know the drill) and our friends at the AAP. They have combined forces to release an incredibly valuable tool that analyzes negotiated payment rates across the country. For free.
Paul provides an in-depth analysis of negotiated payment rates for 70 common CPT codes essential to primary care pediatrics. In collaboration with the AAP, he then created a series of - again, FREE - on-line tools to help you dig into your payment landscape. He has a state-specific research tool, a national comparison, and a payer comparison (by state).
What would you do with this information?
Benchmark Your Rates: See how your current contract rates for key services compare to state and national averages.
Analyze Payer Performance: Compare negotiated rates side-by-side for major commercial payers (Aetna, Cigna, UnitedHealthcare, and the Blues).
Prepare for Negotiations: Arm yourself with actual data. Instead of just saying you feel underpaid, you can go into negotiations showing precisely where a payer’s offer stands against the market benchmarks.
This initiative directly supports independent practices by promoting transparency. It provides the statistical benchmarks needed to assess payment fairly and supports advocacy efforts for sustainable reimbursement. Having access to this level of data helps level the playing field when dealing with large insurance carriers.
This is exactly the kind of data-driven advocacy our community needs. Bravo, AAP, for supporting this!
Go down the rabbit hole here!