Physicians regularly miscalculate their non- Medicare fees, which means that revenue is slipping away. Have you reviewed your fee schedules lately to determine if you’re getting proper reimbursement for all your services? Now is a great time to take a look and make appropriate changes for 2009. Here are some steps to determine if private payers are reimbursing you at a fair rate.
Physicians regularly miscalculate their non- Medicare fees, which means that revenue is slipping away. Have you reviewed your fee schedules lately to determine if you’re getting proper reimbursement for all your services? Now is a great time to take a look and make appropriate changes for 2009. Here are some steps to determine if private payers are reimbursing you at a fair rate.
• Measure and document what you can control.
• Determine your total overhead expenses.
• Separate physician work, including physician salaries and benefits as well as any bonuses, and practice expense such as staff salaries/benefits, space expenses, office supplies, and medical supplies.
• Calculate your cost per relative value unit (RVU).
• Calculate cost for visit services; calculate cost for treatments and procedures; calculate total cost per treatment.
• Compare your practice revenue with your costs. Be sure to include Medicare and non-Medicare.
• Review what is going on outside your practice.
Performing this review annually will help you set practice benchmarks and perform sound measurements for decision-making. Once you’re done, review your current private payer fee schedules in order to determine whether they measure up to your current costs.
Here are some common FAQs about costs:
Q: What should you expect as payment from non-Medicare payers?
A: We believe private payer reimbursement should be at least 30% above Medicare.
Q: Should you utilize the “loaded” Medicare fee schedule as your basis for negotiating a contract with non-Medicare payers?
A: No Instead, use the unadjusted RVU data because the geographic adjustment factor could potentially lower your payment.
Q: Should you accept the non-Medicare payer contracts as is?
A: No! Remember to calculate and negotiate. If you document the true reimbursement rate, you have more leverage to negotiate with payers. You should include the following:
• Data for expenses-make sure that yours are covered.
• Data that outlines the exact reimbursement amount and details why you are requesting that amount.
• Comparison data on reimbursement for other payers.
Visit neltnerbilling.com for an example of how to calculate fee schedules.
Stay up to date on recent advances in the multidisciplinary approach to cancer.
Oncology Peer Review On-The-Go: Cancer Care Management During the COVID-19 Pandemic
October 28th 2020The newest episode of Oncology Peer Review On-The-Go speaks with 2 authors of an article from the October Issue of the journal ONCOLOGY focusing on effective cancer care management during the coronavirus pandemic.