Practice Management Alert

              This month: The last 5 steps of our in-depth 12-step solution

If you haven't started already, there's no time like the present to begin adjusting your Fee Schedule for maximum ethical reimbursement.

In August we jump-started your fee schedule assessment process with three steps that prepare you to make the most accurate fee adjustments. In September we continued the preparation with four more steps. If you've been following along each month, you're ready for the final five steps offered by Frank Cohen, CMPA, senior analyst with Medical Information Technology Solutions in Clearwater, Fla. The end is in sight - and you'll be adjusting your fees in no time. 8. Establish a maximum charge threshold. You shouldn't allow any of your fees to exceed a certain percentage of Medicare's, because you don't want to price yourself out of your own market. Just like your minimum charge threshold (see September issue, page 70), Cohen recommends you base your maximum charge threshold (MaxCT) on your practice's competitiveness level, which should break down as shown above. Identify fees above your maximum charge threshold: As you did with your minimum charge threshold, go through your fees and identify any with a conversion factor above your established maximum charge threshold. You'll want to examine the fees for these codes and look at your reimbursement levels to see if keeping the fee so high is beneficial (or if the fee is simply excessive). Lowering an excessively high fee will reduce your write-offs and not affect your reimbursement. 9. Find an average conversion factor for each coding category: surgery, radiology, pathology, medicine and E/M. To find your category conversion factors, multiply each fee in a coding category by the annual frequency (TPY) and put the amounts in column seven of your spreadsheet - this number is your total fee for the code. Then multiply each code's RVU by the annual frequency and put the amounts in column eight.

Example: Based on the sample spreadsheet (page 79), you would multiply 70 (column three) by 59 (column four) and get a total fee of $4,130 (column seven). Then you would multiply 2.07 (column five) by 59 (column four) and get a total RVU of 122.13 (column eight).

Determine a total sum for column seven and column eight, and then divide the sum of total fees by the sum of total RVUs (divide total of column seven by total of column eight). The number you get is called a frequency distributed average, or category conversion factor (CF). You'll use these category CFs when you adjust your fees.

Continuing example: To determine the category CF on the sample spreadsheet (See next article), you would divide $98,250 [...]