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Thread: NEED HELP!!! Pricing for visits, procedures, etc

  1. #1
    Join Date
    Apr 2007
    Columbia, TN

    Exclamation NEED HELP!!! Pricing for visits, procedures, etc

    AAPC: Back to School
    Can anyone give me some suggestions on calculating prices for office visits, procedures, etc for billing. I know to use Medicare's fee schedule as a base and not be lower than that, but I was wondering what percentage people were multiplying by.

    Thanks for any help!!

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


    It really depends on what you've negotiated for contracts with your commercial payers. You don't want to price any of your services lower than your highest contract. Then use that calculation to determine the % for all of your fees. I don't think there's a standard: I've seen fees that have been priced according to a fee schedule, and also based on a percentage (150-250% of Medicare). And fees can be priced based on National Medicare, and some are priced based on your local carrier.
    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
    Join Date
    Apr 2007
    Columbia, TN


    Thank you. The billing manager at the office I used to work for wouldn't share the formula, so I have been trying to figure this out the best I can.

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