Wiki Setting Fees For A Practice

[psl2012]

I am new and not so new to the forums, but I have been asked to help coming up with pricing for a behavioral health practice. This is new to me, so I have been reading a lot of different things. Most of the information I have read is stating that when pricing for a practice it is advisable to see what other offices are charging for their services (in your area), or based off CMS's fee schedule a rule of thumb that can be followed is to charge 1.5 - 2 x's the fee, or use your highest paying private carriers rate with a little tweaking? Can anyone tell me how you have tackled this process and how it has worked out?

I do understand as stated before in the post that we will only be paid our contracted rate from our payers no matter what our charges are, but I am more concerned about our self pay patients. Any information will help.

Thanks

 

[seanny]

I took what other clinics are charging, our highest payers, and our costs of doing business to come up with a fee schedule. I increase the prices 10-15% biannually. Also, offering a discount to cash or same-day payments is helpful to keep the A/R down

 

[cathy@eyebillforyou.com]

Most practices I have worked with start off at the 1.5 to 1.75 x over the Medicare allowable rate for participating physicians. Depending on the speciality and the location we may go up on the price a bit. Such as a specialists in Washington DC or some parts of Northern Virginia. Its a good place to start.

Cathy

 

[ptmbservice]

Fee Schedule rules/Law

I too have a question regarding fee schedule. I am looking for web sites or documentation that shows proof a medical practice needs to follow the same fee schedule. My reason is the practice I bill for ( 20yrs ) in now allowing personnel injuries to be treated at the practice. I have only billed/coded workers comp and pvt ins companies. So the practice choose another out source facility to incorporate their PI liens. Now they want me to comply to the fee schedule of the PI billing service, who...charge fees off the charts...so to say. I continue to hear " it is the law" we need to have the same fees. Even though we both are independent and bill/code from outside the practice facility. I am now looking for proof of this. Thank You!!!

I am new and not so new to the forums, but I have been asked to help coming up with pricing for a behavioral health practice. This is new to me, so I have been reading a lot of different things. Most of the information I have read is stating that when pricing for a practice it is advisable to see what other offices are charging for their services (in your area), or based off CMS's fee schedule a rule of thumb that can be followed is to charge 1.5 - 2 x's the fee, or use your highest paying private carriers rate with a little tweaking? Can anyone tell me how you have tackled this process and how it has worked out?

I do understand as stated before in the post that we will only be paid our contracted rate from our payers no matter what our charges are, but I am more concerned about our self pay patients. Any information will help.

Thanks