General Category > General Questions

Different Fee Schedules

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dfranklin:
Can a provider have different fee schedules for different billing types? IE one fee schedule for WC, one for Cash, One for regular insurance carriers etc.  I thought this was illegal?

Thanks!

Pay_My_Claims:
Do you mean the provider is charging a different price for WC cases, Cash clients, and insurance carriers??
If so, no he can't do that.

PMRNC:
Its not illegal to have multiple fee schedules, but there are many things wrong with having multiple fee schedules.
The first being the reporting... carriers determine fee schedules by statistically watching and gathering data from providers, a provider reporting the allowable doesn't report properly thereby knocking the system off..
The second reason is data and accuracy. Let's say a year or two down the road the doctor wants to know..hey which carrier is dead weight for me and show me where I am losing money. You can't because you didn't put in the adjustments and bill "your" fee. 

Pay_My_Claims:
He said fee schedule, but I didn't interpret him to mean the fee schedule he is contracted with in regards to the payors. (IE his BCBS fee schedule, his Medicare fee schedule, his WC fee schedule etc etc) The way he is reimbursed by these providers. I read it as he (the provider) is billing Comp, insurance, private pay differently. The provider has a different set charge per payor.

PMRNC:
Maybe I did misunderstand..
I thought he meant billing each carrier according to their fee schedule rather than ONE fee set in the office per provider
 

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