Fees

How Important is Your Fee Schedule?

Did you know that inconsistent and un-reviewed fee schedules can lead to some of the following occurrences:

Prompt an audit or some level of claims review

Hardship Discounts

Insurance premiums and deductibles are going up and coverage seems to be going down. Even with ObamaCare, there will be plenty of folks out there without insurance or coverage for certain types of services. The shift, referred to by some as the “rise of the self-paying patient,” is creating nothing shy of a crisis for many healthcare providers.

Financial Management Resources (Resource 124)

When it comes to financial management, the following subjects of insurance should be understood, implemented and kept current:

It appears that the repeal of the Sustainable Growth Rate formula (SGR) could finally be a real possibility. On Thursday, March 26, The U.S. House of Representatives overwhelmingly passed H.R 2, The Medicare Access and CHIP Reauthorization Act which includes both repeal and replace the flawed SGR formula that has caused a great deal of disruption to the Medicare payment system over the last several years. H.R.

Sustainable Growth Rate (Resource 230)

What is the Sustainable

Can You Charge for Requests for Records?

By Samuel A. Collins
Feb 2010

Question

I am getting numerous requests for records from patients, attorneys and third parties. I believe I can charge for this, but how much can I charge and are there specific codes that must be used?

Answer

Fee Resources (Resource 171)

The establishment of appropriate fees for services is one of the greatest challenges in health care. You need to understand the following concepts:

Consumer Driven Plans (Resource 154)

Consumer Directed Healthcare Plans (CDHP) were developed as a way to shift the control of healthcare dollars from the insurance companies to the patient (consumer). The goal of these types of plans is to allow the patient to take a more active role in their own health and healthcare decisions in an effort to control costs.

Establish Patient Financial Responsibility (Resource 149)

Financial responsibility (insurance, cash, etc) should be established as soon as possible, preferably before the patient comes in for the first visit. Both provider and patient need to understand who is responsible for payment of services. The patient needs to understand what they are responsible for versus what the insurance plan or company will or will not pay. Consider the following:

TENS Rentals

Q: How do you submit TENS (Transcutaneous Electrical Nerve Stimulation) rentals for reimbursement? I have some insurance companies that pay without question and others that deny this.

A:Use the correct TENS unit code, either E0720 for two lead or E0730 for four lead, and append the modifier -RR to designate Rental. Example E0720-RR.

Other popular supply modifiers include -NU to signify a new product and -UE to signify the sale of a used product.

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