Setting your Fee Schedule: Tools and Tactics

Why This Topic Matters

Fee schedules affect profitability, payer contract negotiations, and the administrative consistency of a medical practice. Understanding the general methods and data sources used in fee setting helps practices evaluate whether their charges are defensible and aligned with operational goals.

Article Sections

1. Why evaluate your fees?

   Introduces the business reasons for reviewing a practice fee schedule and emphasizes the role of cost awareness and profitability.

2. Pricing philosophies

   Summarizes several broad approaches to setting fees, including cost-based, market-driven, relative value-based, and blended methods.

3. Tools and data sources for fee analysis

   Describes the general records and external data sources that can be used to evaluate pricing and support fee schedule development.

4. Initial analysis of evaluating your fees

   Outlines a high-level comparison process that uses practice billing information and payer data to identify which services need review.

5. Using market-driven fees and charge data

   Discusses how purchased charge data and related comparisons can be organized for broader fee review.

6. Further review and next steps

   Notes that additional analysis may involve refining fees or using relative value concepts as a benchmark for future work.

7. Three basic rules for establishing or adjusting fees

   Presents general principles for keeping fees competitive, defensible, and aligned with practice expenses and profit goals.

8. Quick Terminology

   Provides short terminology explanations related to relative value concepts and charge statistics used in fee analysis.