If they're not a Medicare contractor, then they don't know what they're talking about. We have dozens of fee schedules - one for the Blues, one for Cigna/Great West, one for Teamchoice, One for UHC (actually, 2 for UHC becaue of one of our providers), and so on...Medicare and Medicaid are the only ones with set fee schedules across the board. Commercial contracts are negotiated annually, and vary from practice to practice.
Now, if this is an issue of a supplemental policy not having the same fee schedule as the primary payer, then they may be technically correct. You have to honor both, if they don't coordinate benefits. That means, if the primary has a high allowable and happens to pay more than the secondary allows, you have to write off the balance as a contractual adjustment. Let me give a couple of examples:
For these examples, let's say you billed a 99213 at $100 to primary payer A, and secondary payer B.
#1 Payer A allows $95 and pays $70, leaving a $25 copay. Payer B only allows $65, and denies payment, because another payer has paid the full allowed amount. You have to write off the $25.
#2 Payer A allows $80, and applies it to deductible. Payer B allows $60 and pays $40. You may only bill a $20 copay.
#3 Payer A allows $75 and pays $50. Payer B allows $95 and pays $75. You call to verify that they paid correctly as secondary, and if they did, you refund the patient $50.
I'm looking for some actual regulations, but the only one I can think of regarding fee schedules is the one I mentioned earlier, which I think is a provision of OBRA. I'll let you know when I find it, though.
Leslie,
I don't know if the consult codes have been deleted for 2011, because I haven't seen the new CPT, but if they're still in there, they're still valid codes. Medicare no longer recognizes consult codes, though - but that began in 2010.