Practice Management Alert

Question: Im trying to negotiate a new fee schedule with a payer. This payer wants me to give them the actual allowed amounts from a couple of other payers so they can compare. I dont like this in the least, and I think I heard somewhere that you cant disclose one carriers fee schedule to another. Is that right?

Ohio Subscriber

Answer: You are correct to question this practice, and you generally should not give out information on what other payers fee schedules are. If you check your payer contracts, youll likely find that the fee schedules are confidential between the insurer and the individual physician.

Each payer should set its own fee schedule independent of what other payers fee schedules state. Insurance companies are not supposed to share fee schedule information with each other, and, just like they are not allowed to talk to each other about their mutual fees, they cannot get the same information from you.

Exception: Medicare rates are, of course, public knowledge and are available online (www.cms.hhs.gov) to anyone who wishes to review them.

Best bet: Proceed cautiously with this payer and the contract negotiation. Watch for other signs of shady business practices to ensure that youre not setting your practice up for a disaster with this payer. Also, keep in mind that the success you have with a third-party payer is more than the fees; it is also how they pay on modifiers, their global days, what they base their bundles on, their timely filing timeframes, their timely payment periods, their appeals process, their guidelines for medical necessity, and frequency among other issues. So, look at all the aspects that affect the final income your practice can earn from a payer, not just the fees.