Medical Billing Forum

General Category => General Questions => Topic started by: Tifsmom1 on June 17, 2014, 09:19:51 PM

Title: Rates
Post by: Tifsmom1 on June 17, 2014, 09:19:51 PM
How do you all set your rates???? Do you have standard rates that you care across the board or do you set the rates based on each individual insurance contract?
Title: Re: Rates
Post by: Michele on June 18, 2014, 07:25:41 AM
Do you mean the rates the provider charges for their services?
Title: Re: Rates
Post by: RichardP on June 18, 2014, 10:26:18 AM
Assuming rates for services and procedures, our clients usually charge the Medicare allowed rate plus 30%.

Note that is what they charge.  That is not what they get paid from the insurance carriers.
Title: Re: Rates
Post by: Michele on June 18, 2014, 02:19:27 PM
Assuming rates for services and procedures, our clients usually charge the Medicare allowed rate plus 30%.

Note that is what they charge.  That is not what they get paid from the insurance carriers.

That is the rule that our providers use as well.
Title: Re: Rates
Post by: kristin on June 18, 2014, 03:24:11 PM
I do things a bit differently, in that I figure out which insurance company we are contracted with(which is all of them) pays the highest amount for a particular charge, and I make that the charge across the board, rounded up to the nearest dollar amount ending with a 5 or a 0. In most cases, our BCBS contract pays the most, but sometimes it is Medicare. So if BCBS allows $78 for a 99213, I make the charge amount $80 across the board. If it was $73, I  would make it $75.

I have a provider I bill for who wanted his fee schedule to be the Medicare allowable, doubled, then he wanted 30% more added on top of that. Seeing as how he almost exclusively billed Medicare and Medicaid, this made no sense to me. Was he trying to run patients off with those prices? Eventually he saw that all he was doing was inflating his AR for no reason, and having to take huge writeoff's, so he let me do it my way. So that is something to keep in mind...you don't want your office/doctor to be the only one in town charging $200 for a 99213, when everyone else charges between $80-$100. Patients talk, and that isn't what you want them talking about.
Title: Re: Rates
Post by: PMRNC on June 18, 2014, 08:45:25 PM
Alice and Michele have a great E-book about pricing your services. PMRNC also has an area on our website devoted to pricing and formulating fees. You can also search the forum here and you will find various posts to help you set fees.