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Review Fee Schedule When was the last time you

reviewed your fee schedule? I have asked this

question of many practice managers, and I have

heard answers from "annually" to "never." If you

are not reviewing your fee schedule on an annual

basis, there is a good chance that your practice is

losing money. On many occasions, the amount a

practice charges for a procedure is below the

maximum allowed by the carrier. Not surpris-

ingly, when this is the case, the

carrier gladly pays the lesser 

amount. So if a carrier will pay

$80.00 for CPT 99214 and you billonly $70.00, the carrier will pay

you $70.00. Thus, even though

you collected 100% of the charge,

you just lost $10.00!

There are many places where you

can find helpful information when

reviewing your fee schedule.

Many look to the Medicare

schedule and set their fees at a multiple of what

Medicare pays for a particular procedure. For 

example, if Medicare pays $65.00 for a 99213,

some practices will set their fees at twice that

amount; in this case, $130.00.

As the calendar has now turned to a new year, I

am sure that many of you out there have made

your New Year resolutions. I always like making

resolutions, because I look at them as a way to set

goals and apply the necessary focus toward

achieving them. Goal setting, whether personal or 

professional, can motivate us and those around us.

With an eye to medical billing, there are several

resolutions that you can make as we

head into the year ahead:

Revise Superbill  One of the mostimportant documents in your billing

workflow is your superbill. As we all

know, a good superbill contains the

most commonly used CPT and ICD-9

codes in your practice. Unfortunately,

in many practices, superbills contain

deleted codes. If these codes are used

to bill for a procedure, the claim will

be denied. By carefully reviewing all

codes on your superbill, you are forcing yourself 

to stay current on all coding updates affecting

your practice. I have always believed that a

superbill is akin to the foundation of a house. If it

is accurate and complete, it will serve as solid

underpinning for your billing department.

Goal setting,

whether personal or 

professional, can

motivate us and 

those around us.

New Year Resolutionsfor the Medical Biller by Ronald E. Nyman, Esq.

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MediStar 

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Other trademarks are property of their respective owners.

not had time to do it as each day’s work seems torun into the next. Just as Julie Andrews once said

"Manners matter," I would say, "Coding counts."

It is generally accepted these days that practices

lose significant amounts of money due to

inaccurate or incorrect coding. Coding seminars

can help to address this problem by teaching you

which codes to use in which situations and by

alerting you to any new coding changes on the

horizon. For those of you who are really

motivated, you might decide to become a

Certified Coder. Organizations such as the

American Academy of Professional Coders

(AAPC) will provide certification to those who

can pass its rigorous exam requirements.

I know that there are many other resolutions that

you can make for the year but the above three are

always tops on my list.

May you have a Happy and Prosperous New

Year!

Ronald E. Nyman, Esq. is founder and president 

of Medi-Claim Services, Inc.

Others, including myself, refer to Medical FeeSchedule guides which show varying fee

percentiles for each code. These fee percentiles  

50%, 75%, and 90% show what providers

charge across a broad spectrum. For example, for 

99201, the 50th percentile fee is $65.00, which

means that 50% of doctors charge above this fee

and 50% charge below it. The 75th percentile fee

is $75.00, which means that 25% of doctors

charge above and 75% charge below this amount.

For practices where the providers participate in all

major plans, it might make sense to set your fees

in the 75th percentile as this ensures that you will

never bill below the maximum reimbursement

allowed by any particular carrier. Moreover,

having your fees in this higher range does not

adversely affect your patients because your 

providers participate with the major plans.

Attend Coding Classes Okay, you have beentelling yourself forever that you would attend all

those coding classes that would help improve your 

practice reimbursement. However, you just have