Reading a practice's payer mix: what each payer pays per visit
Updated 16 October 2026
Payer mix is the share of a practice's visits and revenue that comes from each insurer, government program and self-pay patient. At the same visit count, the mix sets how much revenue the schedule produces. A practice that adds volume from its lowest-paying payer does more work for less margin. This page shows how to measure what each payer pays, how to compare rates, and how to decide what to do with a contract. Some examples use clinic figures from franchise brands' Franchise Disclosure Documents (FDDs), which franchisors give buyers before a sale.
What the mix controls
The mix sets revenue per visit across the schedule. It shapes accounts receivable, the money owed to the practice for visits already delivered, because each payer pays on its own timetable. It drives denials, the claims a payer returns unpaid. It moves work to the front desk, because high-deductible plans shift more of each bill to the patient. It sets administrative load, because some payers require far more documents per claim than others.
AFC Urgent Care's FDD reports revenue and visits for franchised centers in 27 states. Averan's AFC Urgent Care page finds the amount a visit collects running from $97.36 in Nevada to $196.80 in Oregon. AFC Urgent Care's six Georgia centers see 19.5 patients a day at $150.76 a visit, and its fourteen Florida centers see 27.3 at $105.36. The Georgia centers see 7.8 fewer patients a day and average $21,896 more revenue a center.
What to track for each payer
The practice tracks five measures by payer. It records revenue and collections in dollars and as a share of the total. It calculates effective reimbursement per visit, which is cash collected divided by visits. It counts denials and underpayments, where a payer pays less than the contracted rate. It lists each contract's anniversary date, which is when the practice can renegotiate. It watches whether the patient population is shifting toward higher or lower paying plans.
The figures are an illustration. Payer A sends 3,000 visits a year at $110 each, or $330,000. Payer B sends 2,000 visits at $85, or $170,000. Payer C sends 1,500 visits at $140, or $210,000. Ranked by revenue per visit the order is C, A, B. If Payer B paid Payer A's $110, the same 2,000 visits would bring in $50,000 more.
Benchmarking a contract rate
Medicare's allowed amount gives a common baseline for comparing commercial rates. A payer paying 105% of the Medicare allowed amount differs from one paying 80%. Specialty associations sometimes publish blinded ranges of rates. Brokers can help on larger contracts. Practices that move their rates treat negotiation as continuous work. They track benchmark data, document quality outcomes, know which CPT codes drive their volume, and bring that record to each renewal. CPT codes are the standard codes used to bill each procedure and visit.
The figures are an illustration. A visit code carries a $100 Medicare allowed amount. Payer D pays 105% of Medicare, or $105, and Payer E pays 80%, or $80. The gap is $25 a visit. On 4,000 visits a year from Payer E, that gap is $100,000 of revenue the practice could seek at renewal.
Dependence on one payer
When one payer supplies a large share of revenue, that payer sets much of the practice's margin. A rate change from that payer moves the whole practice. Contracts that renew automatically at the original rate leave the practice at old prices. New contracts signed for patient access without a model of the cost to collect add volume at an unknown margin. Underpayments below the contracted fee schedule go unnoticed unless someone checks each payment against the contract.
The figures are an illustration. A practice collects $3,000,000 a year, and one payer supplies 45% of it, or $1,350,000. That payer cuts its rates by 5%. The practice loses $67,500 a year with no change in its visit count or its costs.
Rate and volume together
Revenue is visits times the rate per visit. Two practices with the same visit count can bill different totals because of their rates. A practice that grows visits at a low rate can add cost faster than revenue. The practice reviews rate and volume together for each payer every quarter.
AFC Urgent Care's 291 franchised centers averaged $1,867,756 in 2025, and its 79 affiliate-run centers averaged $1,793,641. The AFC Urgent Care franchised centers earned $74,115 more on 777 fewer visits a year. Averan's AFC Urgent Care page traces the difference to the amount a visit collects, $146.24 at franchised centers against $132.38 at affiliate centers.
Dropping a payer or going out of network
Dropping the lowest-paying payer needs a full model. The model covers patient volume, referral exposure, other payers in the market, and the cost of carrying the contract. The answer differs from practice to practice. Going out of network works for some specialties in some markets. The result depends on whether patients will pay and on the practice's standing in its market.
MaxLiving's FDD shows insurance rising to 13.76% of the average clinic's 2024 revenue, or $125,071. Averan's MaxLiving page finds insurance dollars up 45.8% while everything else the average MaxLiving clinic collected fell 5.66%. At $54.80 a visit, MaxLiving's insurance revenue equals about 2,282 visits a year. A MaxLiving owner weighing that insurance work has those visits and their payment timetable to model.
What this means for a practice owner
The mix sets revenue per visit, the speed of payment, denials and the front desk's workload. The practice ranks payers by cash collected per visit. It compares each rate with the Medicare allowed amount. It checks payments against the contract to catch underpayments. It keeps a list of renewal dates. It models any decision to drop a payer. In the illustration, a 5% cut from one payer with 45% of revenue cost $67,500 a year.
Getting the payer analysis done
Averan Advisors builds payer-level reporting and contract models for practices through its fractional CFO service. The controller service records collections by payer each month so the analysis has current figures. The Medical Practice Numbers Check includes a payer mix section.
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