Fee Schedule Consultation in Chicago, IL
FEE SCHEDULE ASSESSMENT
Optimizing a practice’s fee schedule is crucial to the financial health of an independent practice; therefore Physician Revenue Solutions in Chicago include a fee schedule assessment within our revenue cycle management solution.
WHAT IS A FEE SCHEDULE?
Providers are often paid based on insurer-based physician fee schedules. These fee schedules define how much a doctor will be paid for services performed. There are typically three levels of fee schedules: Medicare, Medicaid, and Commercial, as a medical billing company we focus on the Commercial fee schedules. Levels of fee schedules vary based on payment rates to the physician and can be determined separately by the various involved parties.
According to the Urban Institute:
“Fee schedules for professionals, including physicians, promote professional activity in general and specific professional activities in particular by providing generous payments for services payers intended to encourage. In many national health systems and throughout the United States, fee schedules are the foundational approach on which other payment methods are based.”
In addition, the Institute lists a few benefits of Fee Schedules
- Fee schedules reward activity and industriousness and promote patients’ access to care because providers get paid more for doing more.
- The approach is consistent with how transactions are conducted in retail markets, so payers can rely on consumers’ and patients’ discipline with cost-sharing to affect service use and prices.
- Fee schedules are well established, with well-described impacts; specific reform proposals have been made to improve fee schedule functioning and performance.
- A fee schedule implicitly adjusts for the different case mixes different clinicians and practices experience, thereby paying comparatively more for sicker patients that need more services.
Things To Consider When Negotiating A Fee Schedule
Negotiations between the provider and the insurance company will determine what services (if any) are deemed as primary or secondary. While a primary service is covered under the fee schedule, a secondary service is dependent on a primary service being performed and is “reimbursed” as part of the primary service payment.
Commercial fee schedules will often deem fewer services as secondary and will see a payment rate tied to more services than Medicare or Medicaid. Commercial fee schedules negotiated between two parties can vary by state, region, payor, and/or provider. It is likely a provider may accept different fee schedules from different payors.
Providers agree to fee schedules to avoid patients defaulting on the member cost-share amount after the insurance has paid what they consider allowable. Providers also agree to a fee schedule to be considered an in-network provider, which means insurance companies will typically help steer additional members to the provider.
Commercial fees can be hard to discern since most insurance companies do not provide the fee schedules.
In general, commercial schedules can be compared to Medicare/Medicaid reimbursements to determine their value. Fee schedules that match or are below the Medicare schedule are considered beneficial for the payor. Conversely, fee schedules that are greater than the Medicare schedule are considered beneficial for the provider. It is possible that a payor may negotiate higher commercial fee schedules with a provider that agrees to see the payor’s Medicaid population. This helps to increase the options for the payor’s Medicaid population.
In effect, most fee schedules are set by what Medicare will reimburse. Here is what they have to say about fee schedules and what they mean for providers based on variety of factors:
“Fee schedules for professionals, including physicians, promote professional activity in general and specific professional activities in particular by providing generous payments for services payers intended to encourage. In many national health systems and throughout the United States, fee schedules are the foundational approach on which other payment methods are based.”
Contact Us For a Fee Schedule Consultation in Chicago, IL
Because Physician Revenue Solutions always has their eye on changes to coding and billing, we lookout for Medicare changes to fee schedules, as these will have a downstream effect for insurance providers’ fee schedules.
Contact us today to learn more about how to maximize your bill and fee schedule earnings.
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