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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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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