Fee Schedules and Uniform Billing

This is the time of year everyone starts thinking about revamping their lives and business for the upcoming New Year.   One of those items that gets on the "TDL" is increasing fees. Many clinics haven't changed their fees in years and the issue with that is the cost of living increases and so should the clinics fees.

 

The UCR and insurance fee schedules are determined by the average fee for each service. If every office kept the same fees year after year, it would pull down these averages.   This could definitely be an issue with fees staying the same over years.

 

So, how do you manage increasing your fees?   There are a couple of methods. One is charging 1.5 to 2 times the Medicare fee schedule. You can easily get the fee schedule for your codes for free at www.cms.gov.   Another method is to increase them according to the http://www.fairhealthconsumer.org/. Yet finally, another way to increase them is a certain percentage increase over the fee schedule that has been in place.

 

 

Now that we have established fee schedules, this podcast would be lacking if we didn't discuss uniform billing practices. Uniform billing practices demand that providers charge insurance companies and patients alike. The only exception to this rule is a discount may be given to either party, insurance or patient, if the party pays at the time of service. Of course, this means, they have to pay at the time of service , not tomorrow or next week.   In addition, the discount should not be over 15% from the full rate otherwise it may be seen as an inducement.

 

Finally, the only other time that a discount may be given is if the clinic has a hardship policy in place and hardship has been determined be bank statements, pay stubs or tax returns.