Author Topic: Fee Schedule  (Read 2476 times)


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Fee Schedule
« on: July 08, 2011, 10:57:53 AM »
I am the only medical biller in the office and have no one to turn to when I have a question. I'm hoping that someone can answer my question. I'm in Arizona and the doctor has asked that I review our fee schedule and update it. I have no idea how to do this. Please advise, anyone. Thanks!


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Re: Fee Schedule
« Reply #1 on: July 08, 2011, 12:38:08 PM »
This is only MY experience, but here goes.  The doctor has a fee schedule that should be compared with e.o.b.s from all of the insurance companies he/she bills.  The fee you charge should be more than the highest allowed amount per charge.


Blue Cross allows $30.56 for 99202
Blue Shield allows $72.45 for 99202
Medicare allows $40.25 for 99202
Aetna allows $56.40 for 99202

Your fee should be at least $73.00.  The allowed amounts are determined by the insurance companies and are based on a survey they do among providers for particular codes.  If your doctor is the one charging $25.00 for a 99202, he/she will blow the average and the reimbursement for all the doctors in your area will go down.

Medicare will always be your touchbase, and I've read on here before to charge the medicare allowed + 30%.  It's a good place to start, but if the doctor has been in business a while, you have a greater resource for information.  Medicare is a good payer, but they are not the BEST payer.  Most insurance companies can give you the allowed amounts via fax or e-mail as well.  I have found that the faster way is to just audit e.o.b.s you already have.

I hope this advice is sound (Linda and Michele) and that it at least helps you to start!



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Re: Fee Schedule
« Reply #2 on: July 09, 2011, 05:46:58 PM »
Keep in mind that perhaps your doctor has been billing below the allowed amount for specific insurances.  If the allowed amount is the same as the charged amount on the EOB, chances are that the allowed amount is actually higher and you'll want to bump up your charge. It won't necessarily be so, but it's worth a shot.  You don't get penalized for it.


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Re: Fee Schedule
« Reply #3 on: July 11, 2011, 12:58:24 PM »
DMK's option is a good one.  Compare allowed amounts on eobs from major carriers.  Another common method is to take the Medicare allowed amount (available on Medicare website) and go 130% - 150% of that amount. 


Medicare allowed for 99213 is $58.60  so 130% is $76.18 and 150% is $87.90 so the recommendation would be between $77 and $88 for a 99213.

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Re: Fee Schedule
« Reply #4 on: July 14, 2011, 04:58:58 PM »
we set our fee schedule to 5% higher than our highest payer.I would find out what your highest payor is because if it more than 150% you will lose money.


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Re: Fee Schedule
« Reply #5 on: July 18, 2011, 03:16:21 PM »
also remember that once each contract is up, with private insurance companies you can usually negotiate your reimbursements too.