Wiki ASC Billed Charge Amounts

[SirCodesAlot07]

I currently work at an ambulatory surgical facility. Our current billed charge amounts are highly inflated in my opinion. How do you set your billed charge amount? A percentage of Medicare allowable? I hate billing a ridiculous amount when I know we are only getting paid a small portion of that amount. I am looking to revamp our entire fee schedule if I can convince our administrator that our fees are too high.
Thank you in advance!

 

[JAMETH345]

I work for an ASC as well, and I know that patients get angry about the amounts charged, but there is a valid reason for charging high amounts - sometimes (not often) insurances pay the full billed amount. If you're out of network with an insurance, sometimes they pay more than they pay to providers who are in network, though I've never understood that. getting full payment, or near full payment, for a high charge helps make up for low reimbursement, which is what usually happens. If a patient questions high charge amounts I explain that providers can charge whatever they like, but it doesn't matter to them, because the insurance allows a certain amount, and pays based on that, so the amount above the allowed amount gets adjusted off. I use this example, charge amount $1,000, insurance allows $100, and pays 80% - we adjust off $900, the insurance pays $80, and the patient is responsible for $20. I hope this helps.


John M., BS, CPC-A, CPB