January 9th, 2015
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
• Cause claims delays
• Increase provider liability in case of an audit or investigation
• Potentially lead to being paid less than the actual value of a service rendered
• Losing patients or losing referrals due to overpriced fees and higher patient out-of-pocket
• Lead to patient complaints and/or complaints from peer providers in your area
• Liability and penalties for use of dual fees
• Liability and penalties due to excessive and/or improper discounting
Many providers are unsure of where their fee schedule actually came from or when it was last reviewed. As a component of compliance and for other preventive purposes, fee schedules should be evaluated once per year. Just as CMS routinely (usually once per year) updates fees for all regions and we adjust accordingly, all other fees for services should be evaluated as well to maintain consistency. Though this doesn't mean that your fee schedule will change every year, this does allow for provider confidence in knowing that you are using the most current data available to evaluate your practice fee schedule and therefore are able to provide yet another security measure to your practice and minimize or avoid some of those obstacles listed in the bullets above.
So, how can you evaluate your fees?
• Practices should collect the updated CMS information to ensure your records are current
• Verify your local Work Comp fee schedule if there are specific requirements for your state
• Verify your local Personal Injury fee schedules if your state has specific requirements
• Using the current Relative Value Unit (RVU) and the RVU formula, determine the appropriate fee for each of the individual services provided in your practice.
Order your 2015 fee analysis from ChiroCode, complete with all of the 4 elements noted in the bullets directly above. Click here to order.
Please direct all questions or other inquiries to ChiroCode support.
Note: Not all regions will have separate WC and PI fee schedule information in addition to CMS and the standard formula for determining fees. 2015 Fee Analysis will be provided in February upon receipt of the remainder of the materials needed.