Analyzing proprietary data to ensure accurate payer rates for a dermatology practice

The client 

A mid-sized dermatology practice operating in both Massachusetts and Rhode Island had concerns about the market competitiveness of their rates with a major insurance carrier.   

The challenge 

The client wanted to verify its competitive alignment in the Rhode Island market. Within any market, parity in rates keeps rates reasonable, ensuring that providers in a region are paid in alignment with similar providers in their market.  

Our client needed to know how their payer rates with this major insurance carrier compared to other dermatology providers in the market, but they didn’t have access to the data or the resources to investigate. 

The solution 

BerryDunn stepped in and achieved the following:  

• Secured proprietary data and analyzed it by examining payer rates for the top 25 CPT codes for three market provider competitors and compared these rates with our client’s.  

• Confirmed that our client was being underpaid.  

• Took these findings to the major insurance carrier to negotiate a better rate. 

• Pivoted our approach when the insurance carrier wouldn’t agree to a better rate by diving deeper into the data to find a strategy that would align our client’s rates to the market. 

• Determined that competitors were leveraging affiliations, which unite provider groups and improve negotiating clout for the best market rates.  

• Uncovered our client’s affiliation with a Physician Hospital Organization (PHO), which would allow them to access more comparable market rates by using their PHO affiliation to participate with this major insurance carrier. 

• Capitalized on the PHO affiliation to obtain comparable market rates for our client. 

The outcome 

BerryDunn delivered results for our client through in-depth analysis and expert strategy. Our client gained better contract rates that aligned with the market. Without our ability to access and expertly analyze proprietary data, engage in discussions with the insurance carrier, and apply our healthcare market knowledge, our client would not have achieved a more favorable financial position for their payer contract. 

For more information about BerryDunn’s credentialing and payer contract services, visit https://www.berrydunn.com/services/credentialing.