Medical Billing Forum
Billing => Billing => : mca808 October 17, 2018, 02:40:41 PM
-
Hi,
I am going to start working with a new Home Health Agency. I know (in the back of my mind) that each agency should have their own set rates for each service provided. The set rates are what should be used to bill payers regardless of type. The adjustments will be made at the back-end when the EOB's or RA's are received.
The Agency is setting different rates for each contracted account based on the account's fee schedule. Is there documentation out there that shows that this is the not the norm. In fact I believe that it is illegal to bill different insurances different rates, however, I cannot find documentation in my frustration. Please help! ???
-
It's not illegal to charge different fee schedules according to carrier. It is, however not the norm and not practical at all. The ONLY benefit to doing multiple fee schedules is that it keeps your adjustments consistent, but that actually can be a problem when it comes time to renegotiate contracts. If you are doing multiple fee schedules then there is NO way to extract correct data on whether or not the facility is collectiong the maximum allowed. It's suggested to set ONE fee schedule using 100-200% of Medicare fee schedule and post adjustments by carrier. This allows an annual or quarterly review of adjustments to see if the adjustments are too high and it allows you to re-negotiate contracts. Plus your data is completely accurate.
-
Hero Member, INDEED! Thank you for the response. That was very helpful and I will relay the message to the owners. THANK YOU! :)