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.

Confidentiality and Use Restriction: The Contract Scorecard is designed so that results are viewable only by the individual submitting the information. Any results, assessments, ratings, or associated contract data produced by this tool are confidential. They may only be shared with personnel who are expressly authorized and have a legitimate need to know the underlying contract details. Unauthorized disclosure, distribution, or use of scorecard results is prohibited and may violate applicable company policies, contractual obligations, or legal requirements.

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ASC Payer Contract Scorecard