Absolutely—you could do it yourself, but at a significant cost for buying access to the critical data one needs to successfully negotiate with payers.

More importantly the time you would take and lower success ratio you would have would actually cost you in the end.

We, however, bring years of experience and access to all the vital payer data and research tools that are expensive for a single practice to maintain—especially for something you’d use only once every few years.

Doing it in-house often becomes cost-prohibitive and not the best use of your team’s time. We handle everything so you can stay focused on patient care while we secure the best possible rates. As with most of what we offer practices, Done For You is better than Do It Yourself.

Typically we see 10%–30% increases, depending on several factors — payer history, claim volume, specialty, and when your last rate increase was granted. Some payers allow reviews every year, others every 2–3 years, so timing also affects the outcome.

We understand the concern. Our success fee percentage only applies after we have already delivered increased reimbursement for you.

There is no filing fee. You are not paying us to try. You are paying us for the performance we already delivered. We only get paid when you get paid more. You carry no upfront risk. We take the risk and start the work at no cost to you.

We understand the concern. Our success fee percentage only applies after we have already delivered increased reimbursement for you.

There is no filing fee. You are not paying us to try. You are paying us for the performance we already delivered. We only get paid when you get paid more. You carry no upfront risk. We take the risk and start the work at no cost to you.

If multiple payers sit under one parent company, we typically negotiate each payer individually. The exact approach can change based on the relationship inside that parent group.

Some payers move faster when the contract is simple and their internal process is clean. The timeline still depends on the payer.

It also changes by state. The same payer can act very differently in different states.

There is no published list of fast payers. We only know how fast they move once we submit and start the process.

Incremental reimbursement increase is the dollar or percentage increase over your current or previous contracted rates for a given payer or CPT code.

We use this formula:

Fee = (Average New Rate − Average Historical Rate) × Actual Volume (Encounters) × Applicable Fee Percentage

Where:

Average Historical Rate is the weighted average reimbursement per CPT code per payer for the 12 months before signature.

Average New Rate is the new negotiated reimbursement per CPT code per payer.

Actual Volume is the number of encounters for each CPT code submitted to that payer in the prior 12 months.

We compare last year's volume to the new rates. We base the increase on that projection. Typical increases land between 10 percent and 20 percent.

Your billing team verifies. After signing, your team confirms that payments match the new fee schedule.

We recommend that you upload the new fee schedule into your EMR and map all claims, so underpayment is flagged automatically. If you find underpayment, we open a claim process and push it until it is corrected.

Yes. We can include the full formula in the contract.

Here is how it works.

When we negotiate higher rates and you get paid at those higher rates, the performance fee is earned. We do not issue refunds later if the payer drops rates or claws money back. That applies when we only handle contract negotiation.

If TRCB is also doing your coding and billing, the story is different. In that case we see every claim, every payment, and every underpayment. We chase the payer. We fight it. We correct it. For those clients we share the risk because we are managing the full revenue cycle in real time.

So if we only negotiate, the risk after approval sits with you.

If we negotiate and we run your billing, we take that on with you.

By the way, TRCB offers complete RCM services. Coding. Billing. Denial management. AR follow up. Payment posting. All inclusive. Very competitive rates. Ask us today.

Yes. We provide detailed reporting. You will see the recovered amounts and how the 30 percent performance fee was calculated.

All major commercial payers nationwide — we do not negotiate government plans such as Medicare or Medicaid.

Yes, we manage contract negotiations per provider, per state. We handle nationwide.