Understanding Your Payor Mix


In a volatile healthcare environment of shrinking reimbursement and escalating costs of care delivery, it is important for every practice owner to be able to understand and leverage payor mix opportunity. Practice owners must continually make strategic business decisions to maximize profit. Part of the strategy must be a clear understanding of payor mix, visit and referral volume, fee schedule, and net reimbursement. In example, does your practice see a relatively high volume of Workers' Compensation? What is the percentage of network versus non-network referral volume? Is your practice performing FCEs and advanced work rehabilitation services or referring this out? When was the last time you proactively negotiated a better rate with a network, or are you complacent in taking what they offer?


In a practice with high Medicare volume, do your clinicians understand the appropriate utilization and documentation for the re-evaluation code? What are your most utilized CPT codes and is there the opportunity to appropriately utilize codes with better reimbursement?


The payor landscape is dynamic and often a payor may change methodology of reimbursement and the provider may not be aware.  Therefore, Medkita’s team of Performance Improvement Advisors stay on top of federal, state, and commercial changes in payor guidelines. Our clinical experts work with you and your team to improve net revenue per visit and maximize practice profitability by identifying ways to leverage your existing opportunities.


Let Medkita help position your practice for a successful 2018! We are offering a Risk-Free Clinical Efficiency Assessment® which includes a detailed analysis of payor mix and revenue opportunity. Contact us today!


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