The same service, different revenue
Reimbursement for an identical procedure varies substantially between commercial insurers, Medicare, Medicaid and self-pay. A shift of a few points in mix moves practice profitability without any change in clinical volume.
Tracking it properly
Mix should be measured by revenue rather than by visit count. Twenty percent of visits from a low-reimbursement payer may be eight percent of revenue, and the distinction changes how you read capacity.
Contract rates deserve review
Commercial contracts renew, often automatically, sometimes at rates set years ago. Practices that never model the rate against current cost per visit are frequently delivering care below cost under at least one contract.
Self-pay is growing
Higher deductibles mean more revenue arrives from patients directly, and patient balances collect more slowly and less completely than insurer payments. A practice with growing self-pay needs a different collections approach, not just a different forecast.
What to report monthly
- Revenue by payer, as a percentage and absolute.
- Net collection rate by payer.
- Days in AR by payer.
- Denial rate by payer.
The payer that denies most and pays slowest is often not the one with the lowest headline rate.
TallyWise provides this as part of our healthcare accounting services. Book a call to talk through your situation.
