2015 Payer Contract Allowables

January 1, 2015 will be here before you know it and with it will come new contract allowables.

Let’s take a look at a typical “messenger model” contract (the following is an actual contract). You know there is alot that goes into a managed care contract (MCC) – our focus is on the Reimbursement Methodology and the Amendment.

As you can see this contract has a “stated” year (2005) of Medicare (RBRVS), it can also be “current” year RBRVS – this is important.

If on 1/1/15 the allowables go up – do you trust the payer to just move you to the new higher paying fee schedule? Do you even know if your allowables are going to go up (or down)? You can bet if the allowables go down, your payer is going to get you on that lower paying fee schedule on 1/2/15.

This leads us to the Amendment – your allowables are moving one way or the other, which way will it be and will you be ready within the 30 day amendment period to act accordingly?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you would like to see how Office Visits $ allowables have changed from 2013 to 2014 for all 50 States, go to our Contact Us page and select the “Please send me Office Visit $ allowable changes from 2013 to 2014” checkbox.

 

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