Fee Schedules

ckkohler

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Omaha, Nebraska
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Hello!
I have a question that I need some direction on ... I tried to search the forums but didn't know how to phrase the question to get a good hit ... does anyone know if there are rules and/or regulations regarding billing the same fee amount to all payers? I've seen this issue in recent years - and it doesn't seem right to me but have no idea where to search to get the correct answer. Here is my example ...

64622 - 2011 radiofrequency procedure
  • our "standard fee" is $1200.00
If I know a specific payer only "allows" $153.10 - is it appropriate to only "bill" $153.10? I understand about not wanting to inflate the A/R ... but, it would seem to me that by doing so could be cause for concern ... any thoughts???

If anyone has any resources for reference - I would greatly appreciate the help!
Thank you!

P.S. Please contact me through private messaging or Email @ carolyn.kohler@yahoo.com - Thanks!
 
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Location
Martinez, CA
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Fee Schedules: One for All or All for ? ?

The rationale here is to remember that healthcare like everything else in this country cannot behave in a discriminatory manner towards anyone based upon sex, age, race, religion, disability, sexual orientation, ethnic groups or national origin etc., etc. So we always start with ONE fee schedule for ALL.
When the group or physician negotiates a contract with a specific health plan, HMO etc. to provide services to THEIR subscribed members for a predetermined fee, you are then allowed to have a lesser amount accepted as full payment from those members/patients if that is what the contract specifies.
Keep in mind however that from a purely financial standpoint, and check with your CPA on this one - your practice would benefit from charging the same fee as everyone else and making an adjustment on the account afterwards, to the specific contract allowance account for the HMO or plan. For overall record keeping and tax purposes, I believe it makes a difference at year end.
 
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