#214 $44,400 a Year, Just From One Code
Most payer negotiations start with a feeling. This one starts with a number: percentage of local Medicare, the single most useful tool for comparing payer rates.
• The one number: Percentage of local Medicare turns a raw dollar amount into something comparable across payers, localities, and codes.
• Step 1: Pull 12 months of paid-claim data by payer and CPT/HCPCS code, using allowed amounts and units, not charges.
• Step 2: Rank opportunities by payer, CPT, annual units, and revenue gap, not by frustration.
• Step 3: Build a focused, five to ten code evidence package that pre-answers the payer's objections.
Three actions this week:
• Pull 12 months of allowed-amount data for your top 10 to 20 codes by payer
• Calculate percentage of local Medicare for each using the CMS Physician Fee Schedule Look-Up Tool
• Rank by annual revenue gap, not by which payer frustrates you most
Episode breakdown
• 00:00 Hook and EP213 callback
• 00:45 The reframe
• 02:30 The one number: percentage of local Medicare
• 06:00 Step 1: pulling the right data
• 10:00 Step 2: high-volume, low-rate intersections
• 13:00 Step 3: building the evidence package
• 17:00 The five takeaways
• 19:00 Close and next episode
Resources
• Practice Revenue Leak Scorecard: eligibility.natrevmd.com/nrm-revenue-scorecard-v3 (redacted
• 30-Day Revenue Recovery Plan: eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan (redacted
• Metrics Audit Review (free, physician-led): eligibility.natrevmd.com/metrics-audit-natrevmd (redacted
• CMS Physician Fee Schedule Look-Up Tool: cms.gov/medicare/physician-fee-schedule
• Previous episode: EP213, What's Actually Changing in Healthcare Reimbursement in 2027 (redacted