Author Topic: Same fee schedule for medicare as other outpatients  (Read 839 times)

PGA

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Same fee schedule for medicare as other outpatients
« on: January 12, 2011, 02:22:11 PM »
Can a hospital lab bill a different fee schedule for client billing than the fee schedule they bill to a medicare or other  patient that cannot be billed back to the client?  Must the fee schedule be the same for all patients?

PMRNC

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Re: Same fee schedule for medicare as other outpatients
« Reply #1 on: January 12, 2011, 03:58:29 PM »
For a true accounting process, providers should be THEIR fee schedule and there are several reasons for this. One of the biggest reasons is that carriers and Medicare update their Allowables and U&C by standards that are calculated based on what physicians bill out. If you are billing out the fee schedule for what the carrier allows, you are not helping to keep the data updated within the industry. 
Another big reason to bill out ONE fee schedule is so that you are able to collect data regularly to review carrier's by adjustments. For example a provider may ask you to run a report because he wants to see which carrier he's losing money to. If you bill out the allowable you will NOT have a record of the adjustments.

Stick with ONE office fee schedule, leave the carriers to do the calculations, there is NO benefit to doing it the other way.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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