Streamline your cashflow and maximize reimbursements

Begin Improving Your Revenue Cycle Management Workflow

Optimize Revenue with a Fee Schedule Review

by | Mar 20, 2018

When is the last time your practice reviewed its fee schedule?

We find most practices set a fee schedule and seldom perform annual reviews. Fee schedules get outdated just like coding. Every year, payers update their fee schedules for current and new CPT codes, so it makes sense for medical practices to do the same.

What You Could Lose

As payers update their fee schedules, it is recommended practices complete an analysis of their fee schedule to ensure revenue optimization. Having an outdated fee schedule can result in a significant loss in reimbursement. For example, if the practice fee schedule indicates an in-office procedure is priced at $100, that is the amount that will be billed to each insurance company. If that same procedure is on the insurance company fee schedule priced at $120, the insurance company will only pay $100 since that is all the practice billed. This results in a $20 monetary loss each time the procedure is performed. If this procedure is done 100 times a year, the practice has lost $2,000 for just one procedure.

How Does a Practice Complete a Fee Schedule Review?

  1. Obtain the current fee schedule for the practice.
  2. Determine what insurance companies are the top payers.
  3. Obtain the most current fee schedules for the top payers.
  4. Begin the analysis, reviewing what the practice is currently charging versus what the top payers will reimburse based on the obtained fee schedule. The practice office never wants its fee schedule to be less than what the payer will reimburse for a service.

Fee Schedule Review | Next Steps

Once the updated fees for each procedure have been determined, the practice will want to make sure to update the fee schedule in its practice management system. By doing so, the next time a procedure is charged, the insurance company will be billed the updated amount.


    Related Posts

    top of license

    Apply Top of License Principle to Maximize Time and Revenue

    The healthcare industry is undergoing unprecedented change. The transition from fee-for-service to fee-for-value is a big challenge for physicians and care teams. Long-time fee-for-service physicians are struggling to bridge the revenue gap while implementing new workflows and processes to thrive in the new value-based care model. These new processes take time to identify and implement, and many […]
    Read More
    claims process

    4 Ways to Maximize Practice Reimbursements

    Medical practices cannot conduct business in today’s market like they have in the past. Medical costs are soaring, and reimbursement is not increasing at a rate to offset expenses. It is vital that we have a pulse on our revenue cycle to ensure timely and accurate reimbursements. What you could lose There are many cycles a claim […]
    Read More

    Talk to a Billing & RCM Consultant Today

    Streamline your cashflow and maximize reimbursements

    Begin Improving Your Revenue Cycle Management Workflow

    Medical Advantage - TDC Group