Payer Contract & Fee Schedule Review

Know What You're Contracted to Receive and What You're Actually Getting Paid.

Payer contracts can contain complex reimbursement terms, rates, modifiers, carve-outs, payment methodologies, and other provisions that are difficult to monitor on a claim-by-claim basis. DuoSol’s Payer Contract & Fee Schedule Review services help healthcare organizations examine their payer agreements, reimbursement schedules, and payment data to identify potential discrepancies and revenue opportunities.

Your Payer Contract Shouldn’t Be a Mystery.

Understand the Numbers Behind Your Contracts

Payer contracts are often filled with complex language and reimbursement structures. A practice may know its contracted rates, but still have difficulty determining whether actual payments consistently align with those terms.

DuoSol helps bring greater visibility to the relationship between your payer contracts, fee schedules, claims, and payments.

Review Contract Terms

We examine relevant reimbursement provisions and contract information within the agreed review scope.

Compare Expected & Actual Payments

Where sufficient data is available, we compare contracted or expected reimbursement against actual payment activity.

Identify Underpayment Opportunities

We help flag payments that may not align with the applicable contract or fee schedule for further review.

Improve Revenue Visibility

A clearer understanding of payer reimbursement can help your organization make better financial and contracting decisions.

What We Review

Comprehensive Payer Contract & Fee Schedule Support

Every payer agreement is different. Our review can be customized based on your contracts, specialties, services, payer mix, and business objectives.

Payer Contract Terms

We review relevant provisions related to reimbursement, payment methodology, covered services, and other agreed terms.

Fee Schedules

We review applicable fee schedules and contracted rates for the services included within the agreed scope.

Reimbursement Methodologies

We examine the applicable payment methodology where contract information and supporting data are available.

CPT & Procedure Rates

We can review contracted rates associated with applicable procedure codes and services.

Modifier Reimbursement

Where applicable, we review how modifiers may affect reimbursement according to the available contract terms.

Multiple Payer Comparisons

We can compare reimbursement structures across selected payers to highlight meaningful differences in contracted rates.

Expected vs. Actual Payment

We compare available contract or fee schedule information against actual payment data to identify potential discrepancies.

Underpayment Identification

We flag potential underpayments that may require additional investigation or payer follow-up.

Contractual Adjustments

We review available payment and adjustment information to help determine whether contractual adjustments appear consistent with the applicable reimbursement terms.

Our Contract & Fee Schedule Review Process

From Contract Terms to Revenue Insights

Payer contract analysis requires more than looking at a single payment.DuoSol uses a structured process to connect contract terms with reimbursement data.

01

Gather Contract Information

We collect the relevant payer contracts, amendments, fee schedules, reimbursement documents, and supporting information available for the review.

02

Define the Scope

We identify the payers, providers, specialties, procedures, dates, and reimbursement categories included in the analysis.

03

Review Contract Terms

We examine the applicable reimbursement language and fee schedule information within the agreed scope.

04

Establish Expected Reimbursement

Where the available information allows, we determine the expected reimbursement for selected services based on the applicable contract terms.

05

Compare Payment Data

We compare expected reimbursement against actual payment information to identify potential discrepancies.

06

Identify Opportunities

Potential underpayments, rate discrepancies, contract inconsistencies, and other revenue opportunities are documented for further review.

Why DuoSol?

We Connect the Contract to the Payment.

A payer contract sitting in a file cabinet doesn’t tell you whether the correct reimbursement is actually being received. DuoSol brings together contract information, fee schedules, claims, and payment data to provide a clearer view of reimbursement performance.

Detail-Oriented Analysis

Small reimbursement differences can add up. We pay attention to the details that can affect payment.

Data-Driven Review

Where sufficient information is available, we use payment and claims data to identify potential reimbursement discrepancies.

Revenue-Focused Approach

Our objective is to help your organization identify areas where contracted revenue may not be fully realized.

Clear Reporting

Findings are organized so your team can understand which payers, services, and reimbursement areas may require attention.

Revenue Cycle Perspective

Contract performance affects payment posting, A/R, underpayment recovery, cash flow, and overall revenue cycle performance.

Frequently Asked Questions

Answers to Common Questions

Everything you need to know about working with DuoSol. Still have questions? Book a consultation and we’ll walk you through it.

What is a Payer Contract & Fee Schedule Review?

It is a structured review of payer agreements, reimbursement terms, fee schedules, and available payment data to help identify potential discrepancies, underpayments, and revenue opportunities.

Why should we review our payer contracts?

Healthcare organizations can experience changes in payer rates, contract terms, reimbursement calculations, and payment patterns over time. Regular review can help identify potential discrepancies and provide better visibility into payer performance.

Can you identify insurance underpayments?

Yes. Where sufficient contract, fee schedule, claim, and payment information is available, we can compare expected and actual reimbursement to identify potential underpayments for further review.

Do you review fee schedules?

Yes. Fee schedule review can be included within the agreed scope of the engagement.

Can you compare different insurance payers?

Yes. We can compare selected payer reimbursement rates and payment patterns to help highlight significant differences or potential opportunities.

Do you review CPT reimbursement rates?

Yes. Applicable CPT and procedure-specific reimbursement rates can be reviewed when they are included in the available contract and fee schedule information.

Can you review modifier reimbursement?

Yes. Where the contract provides applicable reimbursement information, modifier-related payment differences can be reviewed.

Are You Being Paid What Your Contracts Say?

Let's Find Out Where Your Revenue May Be Hiding.

Your payer contracts represent negotiated financial terms for the services you provide. You deserve to know whether those terms are being reflected accurately in your payments. DuoSol helps healthcare organizations review payer contracts, analyze fee schedules, compare expected and actual reimbursement, and identify potential underpayment and revenue opportunities. Let’s take a closer look at what your payer contracts are actually producing.