What are Fee Schedules?
Fee schedules are a way to look at the entire set of reimbursement data a payer has published for a specific provider. Unlike reports that analyze market-wide data across multiple providers, fee schedules focus on the negotiated rates between a specific payer and a single provider organization.When to Use Fee Schedules
Fee schedules are particularly useful for:- Provider-specific rate analysis: Understanding what a particular provider is being paid
- Competitive benchmarking: Comparing your organization’s rates with specific competitors
- Contract negotiations: Using actual market rates as negotiation benchmarks
- Network analysis: Understanding rate variations within a payer’s provider network
- Due diligence: Evaluating potential partners or acquisition targets
Creating a Fee Schedule
Step 1: Navigate to Provider Search
To create a fee schedule, you will need to go to Provider Search and select the provider you want to create a fee schedule for.Use the provider search functionality to find specific organizations by name, location, or other criteria. This ensures you’re analyzing the exact provider you’re interested in.
Step 2: Select Your Provider
Once you have identified and selected the provider of interest, you will be able to see detailed information about that provider including:- Provider name and organization details
- Primary taxonomy code and specialty
- Geographic location
- Available payer relationships
Step 3: Generate Fee Schedule
After selecting the provider, you will be able to see the “Get Fee Schedule” button. Clicking this will allow you to select the payer you want to create a fee schedule for. Choose from the available payers that have published reimbursement data for your selected provider. The system will show you which payers have negotiated rates available for this specific provider.Not all payers will have published data for every provider. The available payer list will only show those with transparency data for your selected provider.
Understanding Fee Schedule Data
Fee schedules typically include:Billing Code Coverage
- CPT codes: Professional procedure codes
- HCPCS codes: Healthcare procedure codes and supplies
- Facility codes: Institutional billing codes
- Modifiers: Additional code specifications
Rate Information
- Negotiated rates: Specific dollar amounts agreed upon
- Rate types: Fee-for-service, percentage, per diem, etc.
- Billing classes: Professional vs. institutional rates
- Effective dates: When rates are valid
Provider Details
- Organization information: Full provider entity details
- Taxonomy codes: Primary and secondary specialties
- Network status: Relationship with the selected payer
Tips for Effective Fee Schedule Analysis
Provider Identification
Provider Identification
Ensure accurate provider selection:
- Verify the provider name and location match your target
- Check the primary taxonomy code aligns with expected specialty
- Confirm you’re looking at the correct entity (individual vs. organization)
Payer Selection
Payer Selection
Choose the most relevant payer:
- Consider which payer relationships are most important for your analysis
- Look for payers with comprehensive rate coverage
- Prioritize payers with recent data updates
Data Interpretation
Data Interpretation
Understanding the rates:
- Compare rates across different billing codes for patterns
- Look for variations between professional and institutional rates
- Consider the comprehensiveness of the fee schedule coverage
Competitive Analysis
Competitive Analysis
Benchmarking considerations:
- Compare fee schedules across similar providers in your market
- Look for rate patterns that might indicate negotiation strategies
- Consider geographic and specialty-specific variations
Limitations and Considerations
Data Availability
- Fee schedules depend on payers publishing transparency data
- Not all providers will have data with all payers
- Coverage may vary by billing code type and specialty
Data Accuracy
- Information reflects what payers have published
- Rates may not include all contractual arrangements
- Volume-based discounts or bonuses may not be reflected
Temporal Considerations
- Rates reflect active contracts at time of publication
- Updates depend on payer reporting schedules
- Historical rate changes may not be available
Best Practices
1
Define Your Analysis Goals
Clearly identify what you want to learn from the fee schedule before starting your analysis.
2
Verify Provider Details
Confirm you’ve selected the correct provider entity and location.
3
Select Relevant Payers
Choose payers that are most important for your specific analysis needs.
4
Analyze Comprehensively
Look at the full scope of billing codes and rate types included.
5
Document Insights
Record key findings and patterns for future reference and comparison.
Next Steps
After creating and analyzing fee schedules:- Compare with market reports: Use Report Creation to see how individual provider rates compare to market averages
- Analyze multiple providers: Create fee schedules for different providers to understand market variations
- Track changes over time: Regularly update fee schedules to monitor rate changes