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Wiki Chargemaster Fees

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jbeckman

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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
 
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.
 
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