Payments > Insurance Payments

setting fees

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MJ:
Is there a good rule of thumb for determining what to charge insurance companies for E/M codes and vaccines?

ssherman:
Ingenix percentile + x% or a multiple of Medicare reimbursement (3x, 5x, 10x etc).

Or take the # of units associated with the procedure(s) and multiply times a fee (i.e. $100 per unit)

blhoffman:
Please read this article about Ingenix and procede with caution. I know that I have worked for two companies, each a different type of speciality and there is constant trouble with United Healthcare paying claims.

They will pay same patient, same dx, same CPT at different rates from one month to the next. It is a constant fight. The reps. constantly come back with the same route that this is what Ingenix has for the payment. Next month same patient - different amount.

http://healthcare.zdnet.com/?p=1690

 :-\

ssherman:
Using Ingenix as a reference point for fee schedule creation is a pretty common practice, but as pointed out, the values are derived from an insurer. That's why it is generally a good idea to charge above it (or whatever you feel comfortable with).

Collecting on the full amount is another story.

Michele:
Another method is to take the Medicare allowed amount for your area, and multiply by 130-150%.  It is definitely a good idea to go above the set fee schedules by insurers to determine a provider's charges.

Michele

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