How do I build a payer scorecard?
A payer scorecard ranks your payers on how they actually behave — denial rate, average days to pay, underpayment frequency, and percentage of Medicare — so you can see which contracts cost you the most beyond their headline rate. The point is leverage: it tells you which payers to renegotiate, which to escalate on prompt-pay, and where your recovery effort pays back the most.
What actually matters
- Score each payer on denial rate, days-to-pay, underpayment/downcoding frequency, and %-of-Medicare on top codes
- Weight by your volume — a difficult payer you rarely bill matters less than a moderate one that's most of your revenue
- Surface hidden cost: a payer with a decent rate but frequent underpayments or slow-pay is worse than its fee schedule suggests
- Use it to prioritize — renegotiation targets, prompt-pay escalation, and where denial/underpayment recovery yields most
- Refresh it periodically; payer behavior drifts as they update policies and automated edits
Common questions
What should a payer scorecard measure?
Behavior, not just rates: denial rate, average days to pay, how often they underpay or downcode, and where their rates sit versus Medicare — all weighted by your volume with that payer. That reveals the true cost of each contract, which the headline fee schedule hides.
Where Volari fits: The underpayment and downcoding frequency on a payer scorecard is exactly what Volari measures when it reconciles your remittances — turning payer behavior into a number you can renegotiate against.
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