Wiki Standard Charge for Implants/Spinal Cord

[Peke]

Normally, we set our fees according to Medicare + a percentage up from there for our standard fee.

Does anyone have any rules/standards they are using for commecial carriers? Problems is Medicare incorporates the cost of device in the fee but we have commercial carriers that do not. We do not want to over charge our patients? But we want to be competitive also. We are a ASC facility.

 

[dwaldman]

There are rules against discussing fees that carriers are charged is my understanding. It could be seen as price fixing is what I have heard, but I think your question could be answer in general. You could pull payments for the particular CPT for the past year and place on a spreadsheet this what this particular carrier pays for the CPT and this how they pay separately for the implant or they price it as Medicare with the implant reimbursement included in the CPT. Then from there you could get a sense of your standard mark up for carriers that don't pay the implant under the CPT for the procedure.

 

[dwaldman]

Please note, "mark up" I mean instead of include this cost in to the CPT as required by Medicare, what you "mark up" the cost of the implant which would reported under a separate revenue code.

 

[dwaldman]

Or you might already have a percentage or mark up that you add to the cost of the implant and all that you need to do is separate this cost from your CPT facility fee cost. And then double check that you are covering your costs with different payments methods such as payment by ASC fee schedule amount or payment by percentage of billed charges with the implant being paid separately. It would be important to be consistent in what you charge for a particular service regardless of the carrier and it might be billed a different way per payer criteria but again the total price for the service is consistent.