Looking for input on new billing system, fee schedules

pjcurley

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Former Practice Admin, working on developing a billing system in a small EHR organization. While I am pursuing my CPB, I need some help when getting into some details on EMR billing processes.

My question is on Fee schedules. I get the need for multiple schedules, but when creating charges, should the process get the charge based on code and schedule of the primary insurance?
 

SharonCollachi

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The dollar amount billed should be the same regardless of insurance. The fee schedule is what the allowed amount is for a particular insurance company.
 

csperoni

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Exactly what Sharon said. There are all sorts of implications when billing different fee schedules. Just don't do it. I know some practices do it (especially for Medicare), but in my opinion, there are zero benefits, and a potential 100 problems.
If you are working on the software side, you wouldn't be setting the charges (or fee schedules) - that would be done by your clients. Your software should allow for your clients to create a charge for each code, and should have some way to link an allowable amount to each insurance plan the client creates.
For my favorite software, when insurance payments were posted, it automatically alerted if the payment was different, and asked if you wanted to update that fee schedule, write off the difference, etc. There was also a mechanism to easily make changes across the board for both charge and fee schedule. ie - increase all charges by 20%, increase all charges by $20, etc. I didn't do it often, but if every 3 years or so, I wanted to update the charge amounts, it took < 2 minutes. It also made it easy to update the Medicare fee schedule every year (assuming there were no RVU changes for the code).
 

pjcurley

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To Sharon and Christine, Thank you ! I really appreciate you taking the time to help a stranger! Your input is very helpful!
 
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