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Different Fee Schedules

  1. #1
    Location
    Greensboro, NC
    Posts
    67
    Default Different Fee Schedules
    Medical Coding Books
    I had always been told that I could have a different fee schedule for different insurance carriers. The fee schedule for workers comp, or Medicare could be different. Can I have a different fee schedule for say Blue Cross and another one for a Aetna carrier? Please advise.
    Thanks
    C. Robinson

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Fee schedule remains the same
    Our fee schedule is the same across the board. Our reimbursement varies with the contract we have with that carrier. We also have a policy in place (uniformly applied) with respect to discount provided to patients without any insurance who are truly self-pay.

    But once again, the FEE is the same ... the adjustments/write-offs vary.

    F Tessa Bartels, CPC, CEMC

  3. Default Fee Schedules
    You should check with who ever does your contracting with the carriers as the fee schedules will vary- for instance Medicare alone has different fee schedules - all depending on which area you are in.

  4. #4
    Location
    Charleston, South Carolina
    Posts
    641
    Default
    A physician I used to work for had a regular fee schedule, and then one for Medicare - only because we were non-par at the time. I also would suggest checking with your insurance commissioner. I think I saw something a while back that talked about discrimination of some sort for too many different fee schedules. I could be wrong, as it has been a while, but something to double check on.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by FTessaBartels View Post
    Our fee schedule is the same across the board. Our reimbursement varies with the contract we have with that carrier. We also have a policy in place (uniformly applied) with respect to discount provided to patients without any insurance who are truly self-pay.

    But once again, the FEE is the same ... the adjustments/write-offs vary.

    F Tessa Bartels, CPC, CEMC
    I totally agree with Tessa - this is how we operate with the exception of Medicare which sets it's own fee schedule.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    nods in agreement with Tessa & Lisa - the fee schedule is the same for all - the adjustments/write-offs vary...
    Donna, CPC, CPC-H

  7. #7
    Location
    Milwaukee, WI
    Posts
    54
    Default Different Fee Schedules
    I am also in agreement with Tessa and Lisa. Per the anti-kickback legislation with HIPAA, you cannot bill differently if you are participating with Medicare. If you do, it is considered FRAUD. That is the intent of the legislation. So, while you may take different discounts/writeoffs per contract, the original charge must be the same.

    If you bill self-pay patient's differently, there must be documentation in place of financial hardship indicating that they are unable to pay the regular amount in full. I did a paper on this during my Masters program. That is one of the unintended consequences of the legislation. Those who are least able to pay are expected to do so anyhow. The legislation also makes it difficult to write off any portion of a patient's copay, coinsurance or deductible without documentation of financial hardship - to do so could be considered taking a "kickback".

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