setting fees

[luvbuix]

does anyone out there have experience with setting fees for medical services? we are a small practice & want to update our fee schedule. is there a formula involving RVUs & conversion factors? we can't seem to figure it out!

 

[Chelle-Lynn]

There are various ways that provider can set their fee schedule. You are correct that one way is to use the RVU conversion calculations such as:

The formula for 2016 physician fee schedule payment amount is as follows:

2016 Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Non-Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor (CF)

2016 Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor

You can also determine an internal rule such as your charge rate will be 150% of Medicare Fee schedule. The rule of thumb is to be consistent when setting your fee schedule and the same fee amount should apply to all carriers and personal pay patients.

 

[luvbuix]

ok- thanks!

 

[Cheezum51]

As you probably know, the RVU conversion factor may differ between carriers, so, unless you can get each carrier to tell you what their conversion factor is or figure it out yourself from EOBs, I think the 150% of Medicare allowable, as suggested, is a good way to do that and it will cover you so if a carrier pays more for a procedure than Medicare does you won't be leaving money on the table.

This is what we did in my practice.

Tom Cheezum, O.D., CPC