Variability in contracted payment rates by region/health system

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tmvguy03

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How much variability is there by region and/or health system in regards to contacted rates for procedures? I’ve reviewed the CMS website, and for any given CPT code (I.e. 64483) there is a fair amount of variability (~10-25%) by region.

Do the same degrees of variability exist among private payors? I’m not referring to SOS. For example could BCBS have a contracted rate for in office stim trial of X within the Kaiser system, and 0.3X at the smaller private group in the same area?

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How much variability is there by region and/or health system in regards to contacted rates for procedures? I’ve reviewed the CMS website, and for any given CPT code (I.e. 64483) there is a fair amount of variability (~10-25%) by region.

Do the same degrees of variability exist among private payors? I’m not referring to SOS. For example could BCBS have a contracted rate for in office stim trial of X within the Kaiser system, and 0.3X at the smaller private group in the same area?

In short, yes. You have to have leverage or special "added value" to get favorable rates.
 
In short, yes. You have to have leverage or special "added value" to get favorable rates.

I am assuming by leverage, you mean join a large group practice. What is this special "added value" you are referring to to get favorable rates?
 
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