Are we paid what the market pays?
The short answer
Rate compare, a page of Practice KPIs, puts every code you bill next to what Medicare pays and what insurers have published for practices like yours. It shows which codes and which insurers pay you below the middle, and what closing the gap is worth over a year of your own volume.
How it is counted
- Yours is what you were paid per unit, from your own payments.
- The market is the rates insurers have published, one rate per practice, for practices of the same specialty, insurer and network.
- The middle is the middle practice's rate. Each row has a strip: a box for the middle half of practices (the 25th to the 75th percentile), whiskers out to the 10th and the 90th, a tick at their middle and a dot for you.
- You pick the practices. Every practice of your specialty with a published rate, only those within a distance of you, a list of your own, or one practice.
- What is left out is named. A code with too few published rates at an insurer, government payments, and payers that match no published insurer are not compared. Their dollars stay in your totals and the page says how much.
What you see
One table that opens level by level. Each row has your units and your payments, what you were paid per unit, their middle, you against the middle, what their middle would pay on your volume, how many practices are behind it, and the strip. It exports to a CSV file that opens in Excel.
Open Rate compare in the live demo. The demo is the real app on a made-up practice.
What it needs
The same two eBO reports as the rest of the app. To send your practice's rate data, the app sends us your practice's Tax ID, your clinicians' NPIs (public provider numbers) and the list of codes you bill; never anything about a patient. Medicare's fee is worked out from Medicare's own file, which uses CPT codes, and that needs a CPT licence: the page asks you to tick "We have one", then gets Medicare's file.