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The Payer Contract Nobody at Your Practice Has Read

Reimbursement terms, filing windows, and appeal rights live in a contract most practices signed years ago and have never compared against actual payments.

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2 min read · by White Glove Medical Billing
A sealed document tied with cord, edges slightly dusty

Somewhere in your office is a contract with each payer you bill. It sets your rates, your filing deadlines, your appeal rights, and what happens when either side wants out. Most practices signed it once and have not looked since.

What is actually in it

  • The fee schedule, or the basis for one — frequently a percentage of a published rate, which moves when that rate does.
  • Timely filing, which is contractual and varies widely. Yours may be shorter than you assume.
  • Appeal rights and deadlines, including how many levels you get and in what form.
  • Recoupment terms — how far back they may look and how much notice they owe you.
  • Escalation and termination, including notice periods and whether rates renew automatically.

Why not reading it costs money

You cannot detect an underpayment without knowing the contracted rate. Practices routinely accept payments below contract for years, because a paid claim looks identical to a correctly paid claim in every report.

You also cannot argue a filing denial without knowing your actual window, and "we thought it was ninety days" is not a position.

The hour that pays for itself

Pull your three largest payers by revenue. Find the fee schedule basis, the filing window, and the appeal deadline for each. Write those nine facts on one page.

Then take twenty recent remittances and compare the allowed amounts against what the contract says. If they match, you have confirmed something worth knowing. If they do not, you have found a recurring leak that no report was going to surface on its own.

Denials Piling Up?

We handle the revenue cycle end to end — coding by certified coders, claim submission, denial management and appeals, and A/R follow-up, with six reported numbers every month.

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