PayrHealth

October is Breast Cancer Awareness Month.

At PayrHealth, we work with providers across specialties who are on the front lines of screening, diagnosis, and treatment access — and we know early detection depends on more than good intentions. It depends on patients being able to get in the door.
This month, we’re recognizing the clinicians, care teams, and administrative staff working to make screenings and follow-up care accessible to the patients who need them.

👉 However you’re able to, take a moment this month to schedule your own screening or encourage someone you love to schedule theirs.

The end of the year has a way of surfacing the items that have been sitting on the to-do list.

Our October newsletter will cover key considerations heading into 2027 across payor contracting, credentialing, and revenue cycle management, along with practical insights from the work our team is doing every day.

If you'd like to receive it, subscribe below:

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The end of Q3 is when most practices find out whether the contracts they signed are performing the way they were supposed to.

"Signed rates and realized rates are not always the same number," says Kayla Schneider, SVP of Operations at PayrHealth, who oversees revenue cycle management. "Payment variances, downcoding patterns, and policy changes applied after signature all show up in the data before they show up in a conversation with the payor. By the time someone notices the shortfall in the monthly numbers, it has usually been happening for a while."

Her point is that contract performance is an operational question, not a legal one. The agreement sets the terms. What arrives in the remittance is what the practice actually operates on, and the gap between the two is only visible if someone is comparing them.

Reviewing performance now, while there is still time to act before renewal, is what separates a contract you manage from a contract that manages you.

Following a series of acquisitions, a multi-state post-acute care provider faced a challenging mix of underpaid claims, outdated payor agreements, credentialing gaps, and limited network access.

Through a coordinated strategy across claims resolution, credentialing, and payor contracting, PayrHealth helped the organization:

✅ Recover $330,000 in claims payments tied to site-neutral reimbursement issues
✅ Execute 21 contracts since the partnership began
✅ Achieve 10-22% reimbursement rate increases across multiple payors
✅ Expand in-network access for IRF and SNF service lines across multiple states
✅ Improve payment accuracy through credentialing alignment and ongoing payor collaboration

Working closely with the client's leadership team, our approach included claim-by-claim resolution with payors, provider enrollment alignment following ownership changes, reimbursement benchmarking, contract renegotiation, and network expansion initiatives.

The result was not only recovered revenue, but a stronger foundation for long-term growth and payor performance.

Adding a provider, opening a location, or acquiring a practice all have a credentialing timeline attached, and it is usually longer than the growth timeline.

The sequence matters. A new provider can be hired, onboarded, and scheduled while payor enrollment is still in process. A new location can open before it is loaded into payor systems. An acquisition can close before the Tax ID changes have been filed. In each case the work happens and the revenue does not follow.

Questions worth answering before the expansion is announced, not after:

1. Which payors are involved and what is each one's current processing time?
2. Whether the new location needs its own enrollment or can be added to an existing agreement?
3. What happens to Tax IDs, NPIs, and group affiliations in an acquisition?
4. Who is tracking the applications and following up when they stall?

Growth does not create the delay. Sequencing does. Starting enrollment when the offer is signed rather than when the provider arrives is usually the difference.

Q4 planning season is here.

What is the first thing your team is tackling? Contracts, credentialing, denials, or the budget?

Tell us in the comments.

Most rate requests come down to some version of "our costs have gone up."

Payors hear that from everyone. It rarely moves a fee schedule.

What does move it is knowing where your rates sit relative to comparable providers in your market and being able to show it. That changes the conversation from a request into a case, and it changes who is holding the information.

PayrHealth accesses terabytes of market data monthly to benchmark client contracts against regional comparables. It is the basis for 50,000 or more contracts negotiated across all 50 states.

Before your next negotiation, a reasonable place to start: pick your three highest-volume payors and find out what those rates look like against the market. If you are at or near the bottom, that is not a complaint. That is leverage.

🌟 Employee Spotlight: Laura Cabe, VP of Revenue 🌟

With more than 20 years in healthcare, Laura brings a wealth of experience spanning pharmaceutical sales, managed care contracting, strategy, sales leadership, and business development. Throughout her career, she has served in a variety of leadership roles, including National Director of Managed Care, Regional Director of Managed Care, Director of Managed Care Contracting & Strategy, and now leads PayrHealth's Growth Team as Vice President of Revenue.

What Laura enjoys most about her role is the opportunity to connect with healthcare organizations across all specialties and all 50 states. These conversations provide valuable insight into the ever-changing payor landscape and allow her to help providers identify strategic opportunities for growth and improved reimbursement.

"Every organization is different, but the common theme is that they all need help and results."

Outside of work, Laura can usually be found at a baseball field cheering on her two sons, traveling for tournaments, and making memories with her family. Growing up in a small rural Midwestern town also gave her a deep appreciation for rural healthcare and smaller provider organizations.

We're grateful for Laura's leadership, expertise, and commitment to helping providers succeed. Thank you for everything you do, Laura!

Four things worth settling before January 1.

Q4 is when next year's reimbursement gets set, whether or not anyone at the practice is working on it. Swipe through for the short version.

If you can check all four, you are in good shape heading into January. If not, there is time to fix it.

September is National Recovery Month.

For behavioral health and substance use treatment providers, patient access is often limited less by capacity than by whether clinicians are in network and enrolled.

A patient ready to begin treatment cannot wait 90 days for a credentialing decision. Yet behavioral health providers routinely face longer enrollment timelines, narrower panels, and reimbursement that has not kept pace with the demand for services.

Where the operational work sits:

• Getting new clinicians enrolled before their start date rather than after
• Keeping licensure, supervision documentation, and CAQH profiles current so applications are not returned
• Pressing on network adequacy when panels are closed in areas with clear patient need
• Benchmarking behavioral health rates rather than accepting the first schedule offered

Recovery Month is a good moment to recognize the clinicians doing this work, and the administrative teams making sure patients can reach them.