How to Determine Medical Fee Schedule

Picture this: your medical practice is like a ship sailing through the sea of healthcare, and your fee schedule is the compass guiding you to financial success. However, if your compass needs to be updated, you might find yourself shipwrecked on the shores of lost revenue. It's time to set sail on the journey of revamping your fee schedule and discovering the hidden treasures within your practice's potential earnings. Welcome to your ultimate guide on setting up a fee schedule that not only brings in the doubloons but also keeps patients happy and the ship afloat.

Navigating the Waters of the Fee Schedule

Ahoy, matey! A fee schedule is a treasure map that leads you to the maximum reimbursement rates payers are willing to part with for your medical services. These rates are often based on codes like CPT, ensuring you're paid fairly for your assistance. Think of your fee schedule as a code-locked chest that, when unlocked, reveals the wealth your practice rightfully deserves.

Consistency - Your North Star

In this vast sea of medical billing, consistency acts as your trusty North Star. Just like a ship's crew needs to follow a consistent course, your fee schedule should maintain uniformity across all service codes and specialties. When your fee schedule is as consistent as a sailor's daily routine, you can see your accounts receivables clearly. You have the ability to carve out a route leading to a future of financial achievement.

X Marks the Spot - Knowing Your Allowable

Knowing your Medicare allowable is like finding the "X" on the treasure map, and charging less than these allowable can lead to a false sense of victory, especially when dealing with commercial payers whose rates might be higher. But beware! Setting below the permissible means you're missing out on a potential bounty. Keep your eyes peeled on the horizon, revisiting and updating your fee schedule regularly to ensure your billed charges outshine the allowable.

Crafting Your Perfect Fee Schedule

Creating a fee schedule is like assembling a crew with diverse skills to navigate treacherous waters. Consider using a percentage of Medicare allowable as your guiding star. Tailor this percentage based on your payer contracts and the rates charged by other practices in your area. Family practices might set sail at 150-200% of Medicare, while specialists could venture to 300%. Just keep in mind, like the master of your vessel, you wield the authority to chart your own unique course.

The Code of Conduct - Best Practices for Setting Fees

Steady as She Goes: Avoid abrupt fee changes that might startle your patients. Slow and steady increases help keep the ship sailing smoothly.

Market Intelligence: Set fees in line with regional market rates to ensure you're not stranded on the shores of unreasonably high charges.

Unity in Diversity: Maintain a unified fee schedule across all physicians or specialties. This fosters a sense of fairness and equity among your crew.

All Hands-on Deck for Discounts: While uniformity is vital, offering discounts to self-pay patients or those who pay upfront is alright. Just be cautious not to raise the ire of the entire crew.

Cracking the Code: During contract negotiations, focus on the codes that pay the least compared to your peers. It's like finding the chink in the armor of rival pirates.

Read the Fine Print: Like deciphering a mysterious treasure map, thoroughly read payer contracts before signing them. Keep copies of these contracts as your very own parchment scrolls.

Steering the Ship Toward Balance

As you navigate the treacherous waters of setting fees, avoid the dreaded extremes. Charging exorbitantly high rates might cast you as the villain in this healthcare saga while undercharging could lead to a mutiny among your patients. Seek the sweet spot that balances fair pricing with profitability. Regularly comparing your fees to Medicare and private payer allowances will keep your compass calibrated.

Charting a Course to Success

In this grand adventure of setting up a fee schedule, remember that you're the captain of your medical ship. By combining market knowledge, consistency, and a touch of creativity, you'll create a fee schedule that maximizes your revenue potential. With each revision, you're not just updating numbers; you're setting sail toward a brighter financial horizon.

So, gather your crew, polish your compass, and let your fee schedule be the guiding star that leads your medical practice to its rightful share of the treasure trove. As the wind fills your sails and the horizon beckons, set forth with the knowledge that your fee schedule is your greatest asset—a map to the riches hidden within your practice. Anchors aweigh, and may your journey be prosperous!