Maximizing Your Revenue: Understanding CPT Charges on Fee Schedules
Welcome to another informative discussion on healthcare practices and managing your revenue effectively. Today, we explore fee schedules and how to bill correctly for optimized earnings. Whether you’re a sole provider or part of a group practice, setting your CPT codes and fees can be daunting. But fear not; we’ll provide valuable insights and resources to ensure you’re on the right track.
The Foundation – Understanding Your Contractual Agreements
Before we delve into the intricacies of fee schedules, it’s essential to understand your contractual agreements with insurance companies. The first step is to review your contracts and identify how reimbursement is determined for the CPT codes you bill. In many cases, insurance companies will reference Medicare fee schedules as a baseline. But the question remains: how do you know if you’re billing high enough to maximize your revenue?
Analyzing Your Allowables – The Key to Accurate Billing
It’s crucial to analyze your allowed amounts for common CPT codes to gauge whether you’re billing at the right rate. Insurance companies often might not reimburse you accurately, and that’s where monitoring comes into play. By comparing your top 20 allowed CPT codes to the Medicare fee schedule in your area, you can determine the percentage markup applied. If Medicare reimburses $100 for a 99202 code and your insurance provider pays $150, you have a 150% markup.
Anticipating Contractual Adjustments – Ensuring Fair Compensation
To ensure you’re not shortchanging yourself, it’s vital to anticipate contractual adjustments. These adjustments are typically applied when you become an in-network provider, and they reduce the amount you receive. Failing to anticipate these adjustments in your fees can result in you being paid less than expected. To address this, you should always set your fees higher than the expected reimbursement amount. A healthy contractual adjustment will ensure you receive the appropriate payment.
Utilizing Online Resources – The Power of the Optum Customized Fee Analyzer
Online resources can be a game-changer in your quest to optimize your fee schedule and charges. One such resource is the Optum Customized Fee Analyzer. This tool allows you to input your most commonly billed CPT codes and charges, providing insights into where your rates stand compared to others in your region. By understanding your percentile, you can balance overcharging and undercharging, ultimately helping you maximize your revenue. While there may be a fee to use this tool, the investment can pay off quickly when you’re billing appropriately.
In the ever-evolving world of healthcare, managing your fee schedules and CPT charges is crucial to maintaining a profitable practice. Regularly checking your charges and insurance payments is vital regardless of your confidence in your fee schedule. By understanding your contracts, analyzing allowables, anticipating contractual adjustments, and utilizing online resources, you cannot leave any money on the table.
In the comments section, feel free to share your experiences with online resources like the Optum Customized Fee Analyzer or any other tools that have helped you optimize your CPT charges. Please share this post with your colleagues to help them navigate fee schedules and charges. Have a wonderful day, and may your practice thrive!