Fee Schedule Development and Management
Have you ever wondered if you are being UNDERPAID because your FEE SCHEDULE is not created according to healthcare guidelines and demographic localities?
Over the years, program data have indicated that although Medicare has uniform premiums and deductibles, benefits paid out vary significantly by the state of residence of the beneficiary. These variations are due in part to the fact that reimbursements are based on local physician’s prices.
Medicare determines allowed charges using customary, prevailing, and reasonable charge (CPR) method.
Under Medicare, the “reasonable” or “allowed” charge is the lowest of:
- The actual charge made by the physician for that service
- The physician’s customary charge (the physician’s 50th percentile) for that service
- The prevailing charge (set at the 75th percentile of weighted customaries) in that locality for that service
It has been widely reported that physician’s charges for the same service vary substantially in different localities. At CMM, we make sure that your fee schedule is developed appropriately per your demographic area, so you receive every dollar to which you are entitled. We review each of our client’s fee schedules by payer and update them annually.