> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Payer contracting and fee schedules

> Getting the contract itself: choosing your panel, reading the fee schedule, what's negotiable, and the clauses that bite later.

Credentialing proves who you are. Contracting decides what you get paid.
Owners routinely spend months on the first and zero minutes on the second,
then live with the rates for years.

## Choose your panel deliberately

Don't sign everything. Model the employer mix in your area, pick the 4-6
payers that cover most of it, and evaluate each on effective yield: contracted
rate minus the cost of denials and rework, not the rack-rate fee schedule.
Revisit annually. Dropping a bad payer is a legitimate business decision.

## Read the fee schedule before signing

Ask for the full fee schedule for **your top 25 codes by expected volume**,
not the sample sheet. Check whether rates are pegged to a Medicare percentage
(and which year's Medicare), whether they can be changed unilaterally with
notice, and what the multiple-procedure and assistant reductions are. Those
top 25 codes are usually 80%+ of revenue, so this one spreadsheet is the whole
negotiation.

## What's actually negotiable

New solo practices have little leverage on headline rates, but these move more
often than people think: rates on your top codes (ask for a Medicare-percentage
bump, worst case is no), effective date (push for the application date, not
the committee date), timely-filing window, and removal of all-products
clauses. Leverage grows with volume, scarcity of your specialty in the
network, and every renewal cycle. Groups and MSOs negotiate portfolios, which
is much of why [scaling](/guides/become-an-mso) changes the economics.

## Clauses that bite later

| Clause                      | Why it matters                                                 |
| --------------------------- | -------------------------------------------------------------- |
| All-products                | Forces you into every plan the payer runs, including bad ones  |
| Unilateral amendment        | Payer can cut the fee schedule with 30-90 days notice          |
| Silent PPO / rental network | Lets other payers rent your discounted rate                    |
| Recoupment terms            | How far back the payer can claw payments (fight for 12 months) |
| Termination                 | Your exit notice period; 90 days without cause is normal       |
| Timely filing               | Shorter windows mean more free write-offs to the payer         |

## After the signature

Confirm the effective date and load the fee schedule into your PM so
underpayments surface automatically. Then do the operational half:
[portal registration and EFT/ERA](/guides/set-up-payers).

## Related

* [Get credentialed](/guides/get-credentialed)
* [Set up your payers](/guides/set-up-payers)
* [Credentialing vs. contracting](/concepts/credentialing-vs-contracting)
* [Network economics](/concepts/network-economics)
* [Work your denials](/guides/work-your-denials)