Having Multiple Fee Schedules

May 1, 2009

The practice I currently work for has always billed Medicare exactly what Medicare pays. Is there a downside to doing this? Does Medicare place you in another pay bracket? It does keeps the A/R lower than if we charged our fee schedule, but I want to make sure it does not have negative consequences.

Question: The practice I currently work for has always billed Medicare exactly what Medicare pays. Is there a downside to doing this? Does Medicare place you in another pay bracket? It does keeps the A/R lower than if we charged our fee schedule, but I want to make sure it does not have negative consequences.

Answer: There is just one fee schedule for Medicare. It pays what it pays, so you won’t be in another pay bracket.

The only downside is the pain associated with having your own multiple fee schedules -one for Medicare, one for payer X, one for payer Y.

You don’t mention what you do about charging commercial payers. You will want to make sure that you are consistently charging them MORE than Medicare and not making any mistakes.

As far as the perception that A/R is higher if you “overcharge” Medicare, you can begin to measure net collections - how much are you collecting of the amount you are actually owed - instead of gross collections where you measure what you charge against what you bring in.