This article appeared in College Insider in 2017. It has been updated.
If you haven’t reviewed and updated your fee schedule in the past year, you might be leaving revenue on the table. Make sure you get paid fairly for the services you provide by reviewing your fee schedule at least annually. Here are five things to consider:
1. Have one uniform fee schedule for all providers – and for all patients.
One fee schedule makes it easy to compare charges over time and across providers. It also keeps things simple for billers and patients. (Practices in some states may need to make an exception for workers’ compensation patients.) You can, however, offer discounts to self-pay patients who pay at the time of service.
Kevin McGrath, MD, FACAAI, former vice-chair of the ACAAI Practice Management Committee, added, “Never have multiple fee schedules. Some insurance contracts state you can’t charge more than any other contract. You could be voiding your contract or insurers could come back for refunds later that could be very costly.”
2. Understand your payer contracts.
Know the terms of your various payer contracts. Are you reimbursed as a percentage of charges, or for a specific allowed amount? (If you don’t have current copies of your contracts, contact your insurance carriers.) Compare actual reimbursements from private payers and Medicare for key services to your fees for those same services. If you are being reimbursed at 100% of charges by any of your payers, it’s time to review your fee schedule.
3. Think about self-pay patients.
You may be tempted to set your fee schedule far above the reimbursements you are receiving from payers to provide a cushion in case reimbursements increase. However, keep in mind that self-pay patients are price-sensitive. Don’t drive them away with excessive charges.
4. Consider your costs.
Do a reality check; make sure your fees and reimbursements are covering your expenses and you have enough left to make a profit.
5. Don’t collude.
It’s illegal to discuss fees with physicians outside your group, so don’t go there!
Make it a regular practice to review your fee schedule, and you may find hidden revenue to boost your bottom line.