Payer policy
Fee schedule
The list of amounts a payer will allow for each code, either published (Medicare) or contracted (commercial).
What it means in dermatology
The Medicare Physician Fee Schedule anchors most commercial contracts, which are frequently written as a percentage of it. That means an annual conversion factor change moves commercial revenue too.
Practices should hold their own loaded copy of every contracted schedule; relying on the payer's adjudication to be correct removes the only check that exists.
Why it matters to your revenue
You cannot identify an underpayment without knowing the correct payment.
See this term in your own numbers
A free claims audit reviews a de-identified sample of your dermatology claims and returns a line-item findings report — including where terms like this one are costing you money.
Request a free claims audit