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Fee Schedule - Looking for some opionion

  1. Default Fee Schedule - Looking for some opionion
    Medical Coding Books
    Looking for some opionion as to how to arrive at your practice's fees. We are reviewing all of our charges and feel that we need to make some adjustment's to our current fees. We have been looking at charging 125% of the higher reimbursements, but we are not sure if that is the best way.
    I am not asking for your fees - just a good solid way to decide what the fees should be

    Thanks in advance for your information
    Erica Thorne, CPC
    AFD

  2. #2
    Default
    There is a great product that Ingenix puts out called National Fee Analyzer - they take data from claims submitted and can provide (by your zip code) what the average fees are for almost all CPT codes.

    It's a great reference to show that your fees are set based on averages for your market area.

    I hope that helps.

    LSmith, CPC

  3. #3
    Default
    Actually, a correction - if you want the market data by zip code, you have to order the 'Customized' fee analyzer (it costs a little more).

    LSmith, CPC

  4. #4
    Location
    Loma Linda
    Posts
    50
    Default Medicare Fee schedule
    Now that Palmetto is the MAC1 for CA where does one go to find the Medicare fee schedule for physicians? I need this to show all the changes made in 2008 on the fee schedule.

    Please help

  5. #5
    Location
    Charleston, South Carolina
    Posts
    642
    Default
    Check out Palmettogba.com

  6. #6
    Default
    Quote Originally Posted by erica5909 View Post
    Looking for some opionion as to how to arrive at your practice's fees. We are reviewing all of our charges and feel that we need to make some adjustment's to our current fees. We have been looking at charging 125% of the higher reimbursements, but we are not sure if that is the best way.
    I am not asking for your fees - just a good solid way to decide what the fees should be

    Thanks in advance for your information
    Erica Thorne, CPC
    AFD
    Erica,
    I do all of mine by hand!!! yippppie (I hate it ) but let me tell you what I do.
    I get a list of all of the contracts that my practice participates with.
    Next I pull the allowables for every CPT the practice does for every insurance.
    I put all of these in a spread sheet and use Excel to tell me what percentage each insurance pays of the current Medicare fee schedule. (This will help you in the long run - I always always get phone calls, how much does this insurance pay for this, or what percentage does so and so pay for this ... it's such a pain, but I always resort back to the spread sheet)
    I determine who is the highest payer. My highest payer pays roughly 150% of the Medicare fee schedule - so I know that all of my fees must be higher than 150%.
    Then I will make columns for say 160%, 170%, 180%, 200% - I will recommend what I think is appropriate (keeping in mind speciality, write offs, self pay, and occassional off the wall insurances who pay exactly what you charge) and I will let the physician/practice decide. Normally they always go with what I say. (Unless it's a hospital practice, that has to go through regulatory...)
    I always use a % of Medicare to give me my final fee (Most payers always default to a % of Medicare)
    Then as a procedure pops up that they have never done before, just pull up the Medicare allowable and times it out by your final percentage.

    Hope this helps

  7. #7
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    In the private practice that I code for, they charge 150% x the RVU's Medicare has assigned to each code. The fees change at the beginning of each year, sometimes some go up, sometimes some go down.

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