insurance rates

[jmgabbard]

I am new to an office and have found that they file different rates to different carriers, some they just bill that carrier's allowable. I have always been under the impression that you must file the same rate for any given cpt to all in network carriers. Can you clarify?

[Merry]

Many offices use multiple fee schedules as ins. companies pay at different rates

[PMRNC]

It's ok to bill multiple fee schedules, however it's NOT efficient and can actually cause a lot of problems in a practice. First, the data/reporting that might be utilized to do re-credentialing, credentialing or carrier audit of adjustments will NOT be accurate. If your billing the fee schedule, yes, you avoid the adjustment, however you also do so at a great sacrifice in reporting. Second, carriers determine their fee schedules and U&C by conducting data reports based on physicians billed charges, so if your billing the fee-schedule, that is the amount they are using to collect this data.. not good. Your reports are very important not only in determining the health of your practice currently, but they are equally as important in the determination of future costs, analyzing carrier payments, adjustments, etc.  I'm a billing company. I require all clients to have ONE fee schedule, we do true adjustment posting so that we can analyze true adjustable's/payments on a bi-yearly basis.

[RichardP]

What Linda said.

[kristin]

Agree with what Linda said, and Richard seconded.

I don't know of any offices that use multiple fee schedules...not because it isn't allowed, but because it isn't good business practice. The ones I deal with take the highest allowable amount from any given payer, and either add a percentage on to that number and round up to an even number, or just round up from the highest allowable amount to an even number. They then do whatever adjustments need to be done when claims are paid.

Perhaps this is something that you can explain to whoever is in charge, and then offer to make one fee schedule for the office.

[Rclausing]

One other thing to consider would be the likelihood of something called a "most favored nations clause." In effect, it is a contractual obligation that the provider has with an insurance company that stipulates that no one else gets billed amounts less then themselves. This was very common back in the "80/20" days prior to HMO/PPO policies, but I find they are still not uncommon. It's always the best practice to have a single fee schedule.
Rob

[DMK]

Agree with what Linda said, and Richard seconded.

I don't know of any offices that use multiple fee schedules...not because it isn't allowed, but because it isn't good business practice. The ones I deal with take the highest allowable amount from any given payer, and either add a percentage on to that number and round up to an even number, or just round up from the highest allowable amount to an even number. They then do whatever adjustments need to be done when claims are paid.

Perhaps this is something that you can explain to whoever is in charge, and then offer to make one fee schedule for the office.

This is exactly what we've always done.  U&C gets reduced when you only bill the allowed amounts.  Blue Cross pays the worst, United HealthCare pays the best.  We use UHC and add a little bit to up the U&C for our area, otherwise everyone else will start paying Blue Cross rates and we'll all be out of business!

Worker's Comp in California is the exception.  You MUST use their fee schedule or you have no right to appeal unpaid claims.

BTW.  Just moved to Vancouver, WA and I'm looking for a job.  Any offices or billing companies need a hard worker?

; - )

[RichardP]

Office Ally is there.