1. Helping healthcare providers navigate fees
FeeCalc

2. The problem:
Old habits that hurt in a new era of declining reimbursement, increased regulation, and systemic change
Insurance plans have database solutions with sophisticated analytics to create contracts favorable to them
Providers stuck in the past, relying on guesswork, word of mouth, and tradition (i.e. “we’ve always done it this way”)

3. 3 questions with bad answers
How do physician practices decide how much money to charge for services?
Often just by guessing, and look at charges and pulled a number out of thin air. “Just make sure we charging way more than Medicare.”
How do physician practices find out how much Medicare charges, so they can charge more than Medicare?
A few times a year, they hunt down up to a dozen different spreadsheets from Medicare and carrier websites to find out fees for services in their local area.
How do most contract negotiations go between a physician practice and an insurance plan?
Most of the time, practices just accept whatever contract rate is offered, because most payers won’t budge and practices have no leverage or effective argument.

4. What is needed?
A way to quickly find Medicare fees for all service types
Including not just physician services, but also clinical labs, drugs, and equipment, for all 89 Medicare payment localities
A source of impartial charge data for local regions
For a very long time, only payers knew providers’ charge rates, and could use that knowledge to offer contracts more favorable to them
A single format for all this data to save time
Official sources of fee data all use different formats, from PDF to CSV to various editions of Excel; they use different columns

5. FeeCalc: Browser interface

6. FeeCalc: Medicare payment amounts

7. FeeCalc: Local prevailing charges by Geo-ZIP

8. Charge for a diagnostic colonoscopy (45378)
Percentile
Downtown Manhattan
Bethesda
Rural Kansas 45
$1,253.70
$738.42
$747.48 50
$1,332.88
$743.05
$761.85 75
$1,634.03
$823.79
$922.17 85
$1,792.34
$932.81
$1,137.11
Charge for a level 3 established office visit (99213)
Percentile
Downtown Manhattan
Bethesda
Rural Kansas 45
$136.47
$100.65
$89.33 50
$142.72
$103.07
$90.16 75
$181.07
$122.72
$102.20 85
$206.46
$137.37
$112.98

9. The solution:
Web-powered software that levels the playing field, resulting in data-driven business decisions
Providers get access to data and make more informed decisions, more quickly
Insurance plans are forced to face market pressures and negotiate competitive rates to retain beneficiaries

10. 3 questions with better answers
How do physician practices decide how much money to charge for services?
By using a database of 1 billion claims that represents 70% of all commercial claims billed annually. “We know we’re at the 85th percentile in our neighborhood. We know we’re not selling ourselves short.”
How do physician practices find out how much Medicare charges, so they can charge more than Medicare?
They go to a single website, perform data entry one time, and collect Medicare fees for all 89 payment localities nationwide. They save these search parameters for instant recall anytime fees change.
How do most contract negotiations go between a physician practice and an insurance plan?
It’s a back-and-forth based on the data. Practices determine whether it makes financial sense to participate. They set competitive rates, have clear targets in negotiations, and measure financial impact regardless of whether an agreement is reached.

11. ghuang@decisionhealth.com | 1-301-287-2433
Contact
Grant Huang
Product manager |