The beginning of a new year is a good time to update your fee schedule. As reimbursement rates continue to shrink and medical practices struggle to maintain an even cash flow, the importance of updating your fee schedule is more critical than ever. Updated and accurate fee schedules assist in greater control of medical practice costs, help to maximize revenue and accelerate the practice cash flow, but this all begins with review of your fee schedule. According to a recent article by Physicians Practice, the review process is crucial for two very important reasons: First, it will confirm that you are being paid correctly and second, it will help to determine if you are charging enough.
Where to begin?
The most logical starting point to find the dollar amounts associated with specific types of code is your payer contract. If you can’t locate your payer contracts, you can go to the provider section on the insurance company’s website to download a copy of the fee schedule. Most payers require that you log in as a registered provider. EOBS are another good source of information that will show the allowed amounts for each billed code.
Are your reimbursements lower?
Once your information is organized in a spreadsheet, you can review the payments that are coming in to determine whether the payer is properly reimbursing you. If discrepancies are identified, you should call the payer immediately to dig into the details. Ask the representative about the rules for reprocessing the payment for each payer and document your call with a reference number. Set a reminder to check back to see that the reprocessed claim was paid correctly.
Is your medical practice charging enough?
The other side of the fee schedule is to determine if you are charging enough for your services. If payers are reimbursing you in full, you probably need to increase your rates. Once you determine the reimbursement rate, your fees should be 20-30% more than the payer reimbursement rate. This step has a direct impact on your medical practice revenue.
Once you have everything under control, it is a good idea to go back and spot check once every six months or at least annually. Out dated fee schedules and inaccurate fee structure will have a negative effect on your reimbursements, your cash flow and ultimately your profitability.
Source: Physicians Practice