Wiki Billing at fee schedules

[gpiccirilli]

In an effort to deflate my A/R, I was considering billing according to the fee schedule for each insurance company instead of one general fee across the board and writing off according to fee schedule. Is it against the law to bill the allowed amount for each individual insurance company???

 

[nsteinhauser]

There are a lot of reasons why you don't want to do this. Setting standardized charges (your 'billing' or 'fee' schedule) for services you provide (no matter who is paying for these services) is good business practice. Check with the state you are in to see if there are legal requirements regarding this. There are more constructive ways to deal with lowering your A/R.

Maybe you have a set fee schedule already and are just asking about payers you're contracted with? but if you don't have set charges/rates/fees (whatever terminiology you prefer), there is no way to know what to bill payers or patients who you don't contract with. (If a patient wants to pay cash, how will you determine what to charge?) Some payers pay a percentage of billed amounts. Some contracts have provisions that prohibit the contracted provider from billing other payers less than what you contract to bill them. Your standardized 'fee/charge/billing' schedule should therefore remain consistently above all allowed amounts of the government and commercial providers you contract with. Billed amounts can be based on a combination of factors - the allowed amounts of the payers, the professional or facility RVU's, the costs you incur providing the service, the profit you expect, etc. But you want to be consistent and transparent.