Are your competitors being paid more for procedure codes than your practice is?

How much more?

Happy 2024 everybody.  I am playing with a new toy this year.  Insurance carriers are required by law to publish contracted rates by procedure code, but they have made it very difficult to access those rates.  Until now.  Would you like to see contracted rates by procedure code, payer, NPI number, and more?  I have an example of the data in the graphic accompanying today’s podcast.  You will see major procedure codes for an orthopedic practice and a competing orthopedic practice in the same market.  This analysis compares Anthem, Cigna, and United rates for those top procedure codes for the two practices.  Interestingly, for these codes in this market, Anthem is paying the two practices the same rate.  That is not true for Cigna and United.  You will some wide discrepancies between the two payers for the two practices.  For the same service.  How would this data change your payer contracting?  How would knowing what competitors are being paid influence your strategic plans, whether that means expansion, mergers, or major changes in your practice?  This data may drive the most important decisions and the most profit to your practice this year.

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