10/15/2026
When reimbursement rates go unchanged for years, the financial impact can be significant.
A physician-owned urology ambulatory surgery center in Mississippi came to PayrHealth with reimbursement rates that had not seen a meaningful update in nearly a decade. Four of its five largest commercial payors were reimbursing below 100% of CMS, while rising operating costs continued to put pressure on profitability.
Through market benchmarking, custom fee schedule design, and a coordinated contracting strategy between the ASC and affiliated clinic, the organization achieved:
✅ 80% rate improvement with its largest commercial payor, valued at $235,675 in year one
✅ 45.5% increase from a second payor
✅ Built-in 3% increases in years two and three
✅ Two contracts secured, with additional opportunities in progress
The biggest takeaway? Effective negotiations aren't just about asking for higher rates. They're about understanding your market, benchmarking appropriately, and building reimbursement models around the services you actually provide.
