When I saw that that a forum for coding and billing was created, I figured that it would involve very specific coding issues. The following broader topic came up and I thought it might be worth posting it here.
A group of doctors were at dinner the other night. At a nearby table, a group of lawyers from different firms discussed their various government contracts, sharing the hourly rates they charged and received for that work. At another table, several caterers talked about how much they were asking for various chicken or steak dishes when they marketed their businesses to companies around town. At other tables, accountants, architects, and business people all discussed the fees they charged and payments they commanded for their services. At our table, one of the doctors said, ?how much do you get from United Healthcare for a 99214?? Someone else said, ?Discussing that is restraint of trade. It?s illegal; we can?t do it.? And the conversation ended.
It seems obvious that in order to negotiate with an insurance company, it would be invaluable to know what other doctors receive for the same services. We have a publicly available Medicare and Medicaid fee schedule, and that serves as some sort of reference point, but do you ever wonder if your leading commercial payer is paying you 25% less (or more) for any given cpt code than they pay the practice down the street? It is very possible that they are. How would you respond if you had this information? How do we operate without it?
So here is my billing question: is there any legal method by which we can share this information? At one end of the spectrum, I would imagine that if I organized a meeting to discuss the minimum we will accept from UHC, that I would be in violation of the law and in big trouble. At the other end, suppose someone (not a physician) put up a website asking docs to anonymously post their zip code and the amount they are paid for a series of cpt?s from various insurance companies. Is that also illegal? What exactly can we legally do? Does anyone have any ideas? Are we really required to negotiate completely in the dark?
