Practice Management Alert
Choosing Fee Schedules
Question: Do we need to use different fee schedules for private insurance, Medicare and workers' compensation billing? Iowa Subscriber Answer: A master fee schedule is all that is really necessary. Adjustments are made for contracts with insurance carriers and workers' compensation when payment is received. Note: If your practice has a heavy Medicare patient base, you will most likely have a Medicare participating fee schedule in your computer system. Many computer systems can store and process the allowable rates by insurance contract. This is very useful in comparing your fee schedule to your contracted rate per carrier. Because fee schedules change at different times of the year depending on the carrier, this is the most flexible way to track contracted fees. You can adjust the allowables by contract as they change.
Medicare limits the amount a nonparticipating practitioner can bill a subscriber to about 110 percent of the Medicare allowable fee. Your local Medicare carrier issues a fee schedule each year. The schedule lists the fees by CPT code into participating provider fee, nonparticipating provider fee, and charge limit (charge limit is the maximum a nonparticipating provider can bill a Medicare patient).
If you are a Medicare participant, you should submit your full charge and make adjustments when the Medicare payment is posted. This eliminates the need to monitor and adjust individual Fee Schedule on a yearly basis.
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