Updating Your Fees

How often do you update your fees? What resources do you use to update them?These two questions are very important in running your practice. Today I was looking at the reimbursement for 93970. I was comparing the current Medicare allowed for the professional component (26) to the Medicare allowed in 2006. Although the Fed has been printing money like paper sacks, causing a flood of worthless paper on the market, the reimbursement for the professional component went DOWN by some $4.00.It went down not accounting for inflation, increase in minimum wage or any other factor. Medicare expects you to just absorb those dollars. At some point you simply cannot do it anymore!When we look at new practices, that is one of the first things I ask. When is the last time you adjusted your rates. It gives me a good idea of how well that practice is actually being managed.I look at two principle matters when suggesting fees. First I look at the Medicare rate. Once that is determined, I multiply it by a factor of 2.5. Then I look at the 75th percentile for the previous year of all fees charged in the US. Whichever of those two numbers is greater, that is the fee I recommend.That is the starting point. As we work with the practice, we constantly monitor the reimbursements to determine how they are being paid. The structure listed in the above paragraph usually gets most of the allowable in the country, but sometimes we find that rare company that pays that rate in full. When that happens we know we have left money laying on the table and we adjust the fees upward for that procedure, usually about 10% at a time. That generally takes care of the issue but we continue to monitor. You are doing the work, make sure you are getting paid! Your medical billing staff should be on top of each and every payment.

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