Practice Management Alert

Question: Experts say that practices should have updated fee schedules from their payers to make sure they're being paid correctly. How can I get these schedules?

Tennessee Subscriber
Answer: You might get a complete Fee Schedule the first time you sign a contract, but it's likely you'll never see another. Run a productivity report, by CPT Codes, to identify your top 10 or 20 most utilized procedures. Then, submit a written request to each payer for the payment on your top 10- or 20-procedure codes. You will have better luck getting a response from the payer by limiting the request to a small number of services rather than the entire fee schedule. Compare the payment rates to Medicare's for the same codes. Medicare's tend to be used by insurance carriers as a standard for usual, customary and reasonable payment. Reconsider contracts that pay under Medicare fees. Negotiate percentages above them.

You Be the Expert and Reader Questions answered by Felecia Bernstein, CPC, EMT, a coding and reimbursement consultant in Deal, N.J.; Stephanie L. Jones, NRCMA, NRCAHA, CPC, director of audit programs at eCompliance Doc in Miami; Lorraine Goupee, CPC, NRCMA, CCP, compliance officer for quality assurance at Lighthouse Orthopedic Associates in Lighthouse Point, Fla.; Sarah F. Mountford, BA, CPC, accounts receivable coordinator for Physicians Business Network in Overland Park, Kan; and Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J.