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Thread: fee schedule

  1. #1
    Join Date
    Apr 2007

    Question fee schedule

    AAPC: Back to School
    I need to see if anyone can tell me where to find the information stating that you cannot have separate fee schedules for different insurances.

  2. #2
    Join Date
    Apr 2007
    St. Louis East


    Hi jbunni,
    I work in insurance follow up and each insurance company has their own fee schedule. I don't know the specifics on how each is calculated, but I think the physician contract may have something to do with it. Most insurance companies list their fee schedule on their website, or you can request it from them.

  3. #3
    Join Date
    Apr 2007
    Jacksonville River City AAPC


    I'm afraid there isn't a specific "rule" that guides this. It's more of a conglomeration of business decisions and making sure you don't break other rules that guide this answer.

    Technically, I suppose a company could have multiple fee schedules - but then you would have to monitor them frequently for compliance with your contracts. For instance, you couldn't charge anyone else less than you charge Medicare patients. And if you have specific contracts, you'll need to make sure your contracts don't prohibit you from having multiple schedules or any other binding issues.

    It is much easier, from pure business sense, to have a single fee schedule that is charged across the board and then different write-off adjustments to meet the specific contract requirements. This allows you to show consistencey, defend equal treatment (show that you aren't giving prefential treatment to any group), and justify discounts or reductions.

    That's the quick and dirty answer. I know it doesn't give you the specific something 'in writing' you are looking for - but at least gives you some things to consider.
    Melissa Brown, RHIA, CPC, CPC-I, CFPC
    Past Chair AAPC Chapter Association Board of Dirctors
    Past-President, River City AAPC
    Executive Co-Chair, Coding on the River

  4. #4


    What is the goal/desired outcome in having different fee schedules?

    I encountered this at a previous employer who had a two-fold goal: 1. Reducing A/R appearance by only charging what each insurance would pay. 2. monitoring payments from insurance companies to make sure they were paying according to our contracts.

    I was able to succesfully argue that if we weren't overcharging in the first place, our A/R and write offs would be within expectations for our region and specialties. We adjusted our method of calculating the charges and implemented twice yearly review (E&M and physical therapy as one set, procedures in the other).

    When we purchased an EMR/billing system, I was able to convince them to spend a little more money on the program to include the capability of loading individual insurance contracts and allow the billing system to "monitor" the payments for us. This also increased efficiency in the billing department as we didn't have to worry about learning every contract, the program would "alert" us to potential inappropriate payments when they were posted and we could then evaluate that claim and follow up with the insurance company if necessary.

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