#214 $44,400 a Year, Just From One Code

Send us Fan MailMost 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 30-Day Revenue Recovery Plan: eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan Metrics Audit Review (free, physician-led): eligibility.natrevmd.com/metrics-audit-natrevmd 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