First, what is a fee schedule? Your contracted rate fee schedule is what you are supposed to be paid based upon your specific contract with your payers. What you may be paid could be very different from your colleagues, so be sure you know your numbers. This fee schedule is also what your front office use to calculate co-insurance and deductible amounts when your patients are paying at the time of service.
Obviously, with your practices' specific types of codes, the dollar amounts can be found in your contract. Don't have a copy of your contract? You can still get these numbers, here's a few ways to do that:
• You can call the provider representative at the insurance company (payer) and ask them to fax you a copy of your contract with an updated fee schedule.
• Go to the provider section on the insurance company's website, and download a copy of the fee schedule. You have to be logged in and a registered provider in order to obtain this information on their website.
• Look at EOBs and inflow reports from your billing department that show the allowed amounts for each billed code.
You have your spreadsheet with dollar amounts, now what? This is where you need a great set of eyes and someone very detailed focused to review your payments coming in. If you notice that a payer is not paying you properly, get on the phone with them immediately and ask them their rules for reprocessing the payment. Always get a reference number and the name of the person you spoke with. Have a calendar or means of a reminder to go back and check after the 30-45 days they need to reprocess the claim to make sure they are now paying correctly.
You may need to do this for every payer until you are confident you are being paid correctly, and then spot check once you have everything under control.
The other area that a fee schedule will help you is to help you decide if you are charring enough for your services. If you notice that a payer is paying the claim in full, or one to two codes in full, you need to raise your rates on your fee schedule. Find out how much their reimbursement rate is and be sure you are charging 20-30 percent more than that amount. With reimbursement rates constantly shrinking, this is an area that can immediately increase your inflow.
Just be sure you have a fee schedule and that your front and back office staff have a copy so that they can perform the functions of their jobs at the highest level.