Serbin Medical Billing Contract Score

Score one of your payer contracts across nine categories to see how it stacks up. You will get a rating out of 100 points and a clear read on whether it is time to renegotiate.

Payer nameOptional. Gives your result an identity. Plan / productOptional.

0 of 9 scored

Reimbursement Rates vs Medicare 30 points

Enter your weighted average % of Medicare across your highest-volume procedures.

% of Medicare

Top 25 Procedure Analysis 20 points

Share of your highest-volume CPTs above target reimbursement. Targets: Commercial 150%-250% of Medicare, Medicare Advantage 100%-150%.

90%+ of CPTs above target 20 pts 80-89% 17 pts 70-79% 14 pts 60-69% 10 pts 50-59% 5 pts <50% 0 pts

Implant Coverage 10 points

Invoice + 20% or greater, no threshold 10 pts 100% invoice reimbursement 8 pts 80-99% invoice reimbursement 5 pts Threshold > $500 but covered 3 pts Included in case rate only 0 pts

Biologic Coverage 10 points

Invoice + markup 10 pts 100% invoice cost 8 pts 80-99% invoice cost 5 pts Limited reimbursement 3 pts No coverage 0 pts

Multiple Procedure Discount (MPD) 10 points

100/50/50/50/50, no cap on procedures 10 pts 100/50/25/25/25, no cap on procedures 8 pts 100/50/25/0, only 3 procedures paid 5 pts 100/50/0, only 2 procedures paid 2 pts 100/0/0, only 1 procedure paid 0 pts

Billing & Claims Terms 5 points

Base score on timely payment. Bonuses add 1 point each, up to the 5-point cap.

30 days or less 5 pts 31-45 days 4 pts 46-60 days 3 pts More than 60 days 1 pts

Bonuses (+1 each, capped at 5)

Interest on late payments +1 Electronic payment options +1 Favorable appeal terms +1

Renewal & Escalation Terms 5 points

Annual escalator + termination flexibility 5 pts Escalator only 4 pts Automatic renewal with notice rights 3 pts Auto-renewal without escalator 2 pts Locked rates / multi-year term 0 pts

Network & Product Participation 5 points

Includes PPO and MA with strong rates 5 pts Includes PPO only 4 pts Multiple products but poor rates 2 pts Narrow product participation 1 pts Significant exclusions 0 pts

Administrative Burden 5 points

Consider prior authorization requirements, site-of-service restrictions, medical necessity policies, and the appeals process.

Minimal 5 pts Moderate 3 pts High 1 pts Excessive 0 pts

Pick the option that best matches your contract. Leave a category blank to skip it.

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ASC Payer Contract Scorecard