Scope for each practice is confirmed in the engagement agreement, including systems, payers, and queues.
Underpayments hide when nobody has the exhibit
Practices sign agreements, file the PDF, and post payments at whatever the remit says. Years later an analyst cannot tell a contractual adjustment from a payer error because the fee schedule was an amendment nobody saved. Contracting support makes the current exhibit findable and gives billing a way to flag paid amounts that do not match it.
What the work includes
- An index of current participation agreements and amendments
- Identification of fee schedule exhibits, filing limits, and termination notice periods
- A crosswalk from high-volume CPT codes to the contracted rate when the exhibit is usable
- A queue for variances between the posted allowed amount and the exhibit
- Draft outreach to payer representatives for missing exhibits or roster errors
- A handoff to counsel when a term needs legal interpretation
How the work moves
Step 1
Collect the paper that is actually in force
We ask for the signed agreement and later amendments, not a sample contract from a website. Missing exhibits are logged as gaps, not filled in with guesses.
Step 2
Translate terms billing can use
Timely filing, appeal windows, and whether the plan pays a percentage of Medicare are written in plain language next to the clause. Ambiguous clauses are marked for counsel.
Step 3
Compare payment to the exhibit
For a short list of high-volume codes, posted allowed amounts are compared with the exhibit. Variances become questions, not automatic accusations.
Step 4
Keep the file current
Renewals and silent amendments are dated. Billing is told when a new rate should start so old expectations are not used on new claims.
Operational benefits
- Underpayment questions start from a document, not a memory
- Appeal and filing deadlines are visible
- New payer conversations begin with a complete file
- Leaders can see which contracts are missing exhibits
Common challenges
- Some payers will not release a usable fee schedule
- Percentage-of-Medicare language depends on which Medicare year and locality
- Contract terms and the remit do not use the same words
- Negotiation leverage is a business decision the practice has to own
Technology
The index can live in a secure spreadsheet or a contract module the practice already owns. Rate comparisons use posted 835 data. We do not claim access to a national payer-contract database.
Where specialty changes the work
Surgical practices care about global package rates and assistant-surgeon language. Primary care cares about preventive visit rates and quality program appendices. The filing system is the same. The codes on the short list change.
Questions
Do you act as our attorney?
No. We organize terms and prepare operational questions. Interpretation of a dispute, a termination, or a regulatory clause belongs with counsel the practice chooses.
Can you force a payer to raise rates?
No. We can show where the current exhibit is missing or where payments do not match it. Any renegotiation is the practice's commercial decision.
Is this the same as credentialing?
No. Credentialing gets a clinician onto a plan. Contracting is the agreement that says how that plan pays. A practice can be enrolled against an old fee schedule it has never read.