Free tool
What does a fee increase actually change?
A higher fee schedule feels like progress on the page. Whether it puts a single extra dollar in the bank depends entirely on who's paying it, and for most of your patients, the answer is contractual, not up to you.
What actually moves, and what doesn't
Starts with example numbers · nothing is sent anywhereYour practice management software's production report, trailing twelve months, at your current posted fees.
Out-of-network and cash patients: the ones who actually pay what you charge.
How far your in-network allowed amounts sit below your full fee, on average across your plans.
Applied to your full fee schedule: the number every plan's allowed amount is compared against.
A share of your fee-for-service patients. Sticker shock is rare at single-digit increases, but this is your estimate to make.
The number that matters
Raising fees 5% adds about $13,365 a year, all of it from fee-for-service patients, after backing out the 1% you might lose. Every in-network claim collects exactly what it collects today: the schedule doesn’t move until you renegotiate it. What you’ve actually done for those patients is raise the write-off you report from 35.0% to 38.1%.
An increase on paper raises the write-off percentage you report without changing a cent of what any plan pays: the allowed amount is fixed by contract, not by your fee schedule. The number to actually watch is collections, not the write-off line, and this tool assumes coinsurance on contracted plans is based on the allowed amount rather than your billed fee, which is true for the large majority of them.
How to read it
Your fee schedule and your contract are two different documents.
Every practice eventually raises its fees, and every owner eventually has the same quiet worry afterward: did that actually do anything? For your in-network patients, the honest answer is no. The plan agreed to pay a fixed allowed amount for each code when you signed the contract, and that number doesn’t care what you post on your fee schedule. All a fee increase does for those patients is widen the write-off you report: the gap between what you charge and what the plan was always going to pay.
The real money is in the patients whose payment isn’t set by a network: your out-of-network and cash patients. They’re the only ones who actually pay closer to what you charge, so they’re the only ones a fee increase can move. That’s why this tool asks what share of your production comes from them before it tells you anything: a practice that’s 80% in-network gets a very different answer than one that’s 30%.
None of this is an argument against raising fees: a full fee schedule that’s fallen behind cost of living is its own problem, and it’s the number every future contract negotiation gets measured against. It’s an argument for knowing, before you announce it, exactly which patients will feel it and which won’t. A bigger write-off on the report is not bad news; a bigger check is the only thing that is.
Questions
Before you act on it.
Why doesn't raising my fees change what a PPO pays me?
Because the allowed amount is set by the contract you signed, not by your posted fee. A plan agrees to pay $400 for a code regardless of whether your full fee is $500 or $700: raising your fee only changes the size of the write-off you report against that same $400.
So a bigger write-off percentage after a fee increase means I'm losing money?
No. It's an accounting artifact, not a loss. The dollars a contracted plan pays you are unchanged; only the gap between that fixed payment and your (now higher) full fee got wider on paper. If your write-off jumps and your collections don't, that's expected, not a red flag.
Will my in-network patients notice a fee increase?
Almost never. Most contracted plans calculate the patient's coinsurance as a percentage of the plan's allowed amount, not your billed fee, so their out-of-pocket portion doesn't move either. A minority of older indemnity-style plans pay a percentage of your fee up to a cap. Check your specific contracts if you carry any of those.
How do I know if I'm actually being paid what my fee schedule says?
Don't assume you are. Pull a few months of EOBs for a plan you're suspicious of and compare them, line by line, to the fee schedule you actually signed: leased networks in particular are known for paying less than the contracted amount. A fee increase and an underpayment are two different problems; this tool only addresses the first one.
Knowing what actually moves is step one. The course covers renegotiating the contracts that don't.
Related reading
- Going Out of Network: The 90-Day Plan, the Patient Letter and the Front-Desk Scripts9 min
- How to Ask a PPO for a Fee Increase (and What to Do When They Say No)8 min
- Which PPO Should You Drop First? A Ranking Framework7 min
- Leased PPO Networks and Credentialing: Know Which Plans You Are Actually In8 min