Contracted Fee Schedule Match Rate

Benchmarking Report

Contracted Fee Schedule Match Rate

This PDF report includes benchmarking data (in a visual, chart-based format), an comprehensive KPI definition, characteristics of high performers and technical details on measuring Contracted Fee Schedule Match Rate. Purchase and download this easy-to-understand, presentation-ready report immediately to compare performance levels, set attainable performance targets, and push towards best-in-class performance for this KPI.


What is Contracted Fee Schedule Match Rate?

The number claim payments matching the insurer's contracted fee schedule (i.e., the medical service/procedure fee schedule published by the insurance payer) divided by the total number of claims payments made over the same period of time, as a percentage.

Why should Contracted Fee Schedule Match Rate be measured?

Contacted Fee Schedule Match Rate is a metric developed and monitored by the American Medical Association (AMA) to measure the percentage claims paid out by insurance payers that match the amount in the healthcare fee schedule that they publish for use by healthcare providers. These fee schedules are used to estimate how much patients will owe (i.e., patient responsibility amount), and how much insurance companies will pay out to healthcare providers, for various medical services. Various issues can arise when the actual and contracted fee amounts do not match: disputes between patients and healthcare providers, delinquent or hard-to-collect medical bills, administrative work/rework caused by over or under-payments, and disputes between healthcare providers and insurers are potential consequences of fee schedule mismatches.


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