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Thread: Please settle this for me!

  1. #1

    Default Please settle this for me!

    AAPC: Back to School
    I have a little actually huge argument between the Doctors and I. Please all billers can you help me !!!! The Doctors have NOT updated there contracting with insurance companies since the 1980's. Our reimbursement rates for some commercial insurance is 50 to 70% of what Medicare pays. I am under the impression that Commercial Insurance Companys base there fee schedule on the Medicare reimbursement rate, so we should at least be getting paid at 100% of Medicare. Medicare is our highest payer! If I am wrong I will gladly say so, but I need to settle this. I am in New York Downstate. PLEASE HELP THIS IS SO FRUSTRATING!!

    Have a great Day,

  2. #2
    Join Date
    Apr 2007
    Dover Seacoast New Hampshire


    My first response is "how are they staying in business? Are they just automatically re-signing contracts from 1980 without any review of their fees?

    You might want to do a financial analysis of your revenue increase if your commercial payers reimbursed you at AT LEAST Medicare's fee schedule, and then again at 125%. By presenting their financial picture in a way that would help them understand what they're losing out on, perhaps one of them will be motivated to act.

    If they don't want to re-negotiate any commercial contracts, they should at least get paid based on the commercial payer's straight fee schedule, which is likely more than your current contracts. You can contact your payer reps to get a look at the fee schedules, to see if they're more than your contract. I bet they are, depending on your specialty.

    If they "see the light", make sure you budget in a raise for yourself. good luck!
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. #3

    Default Thank you!

    Pam you are a life saver. I am trying to find them documented proof on how they should at least be at Medicare see schedule rates (as I said Medicare is our highest payer). Is there any place I can find this proof?

    Again so grateful for your help,

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