There are several formula’s practices use to find out if they are charging the right amount for services. Some practices simply set their Professional Fees at a percentage of Medicare, some purchase expensive R&C (Reasonable & Customary) books, others try to use the RVU.
Let me ask, what is the root reason to set a fee? What are you trying to accomplish?
No one really thinks about this question – Dr John down the street charges $200.00 for 18 AK removals…so you set your fees at $201.50, right?
It really does not matter what the R&C, RVU or what Dr John is charging. Your charges should be set at the highest negotiated fee schedule.
Example: You are contracted with one of the Blues and they allow $250.00 for 17004.
Dr John charges $200.00 and you charge $201.50. Using anything but your most current fee schedule could set you up for a loss of revenue; in this example it would be $48.50 which doesn’t sound too bad until you realize you have performed 50+ AKs this year and your loss is more like $2,425 or more!
MCR gathers all your contracted fee schedules and know from day to day what the allowed amounts are. This task may take 60-120 days depending on the payer. Once the information is gathered we review it against your professional fees. This is powerful information and at a glance you know how your contracted payers stack up to one another. All of your fee schedules should be higher than Medicare, but through evaluating these schedules we find time after time most practices have 1-4 payers that allow less than even Medicare. These are contracts you may want to reconsider based on patient base, time spent and reimbursement.
Professional Fee review is a inclusive feature with MCR
The Average physician loses $10,000 – $50,000 annually due to improper filing and lost claims.
81% of all practices show diagnosis coding as one of the top 5 reasons claims are denied!
15% of all denied claims are NEVER refiled.
10% of all secondary claims, outside of Medicap, are never submitted!
25% to 43% of a physician’s gross income is spent on billing expenses.