Can anyone recommend a best practice for determining fees to be charged in a physicians office? We currently get the BCBS fee schedule and UHC fee schedules. Is there a formula for drugs different than CPT? Is there an industry standard for a markup, or is there any markup? Lastly, how do you calculate self pay discounts? My concern is that if markup is 10% over fee schedule, and offering a 20% self pay discount, our cost of items could be higher than the actual self pay discount charged. Any recommendations are appreciated. Please respond to post or email to: jbeckman@pinelakehealth.com
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Chargemaster Fees
- Thread starter jbeckman
- Start date
lbennett@azaleahealth.com
Contributor
Since you must bill all insurance companies the same rate I would recommend billing insurance companies 2.0-2.5 times the published Medicare rate (depending on your commercial reimbursement rates).
You cannot bill self-pay patients below the published Medicare rate so I would make the Medicare rate your self-pay rate.
You cannot bill self-pay patients below the published Medicare rate so I would make the Medicare rate your self-pay rate.