Home Forums Discussions General Discussion Different Fee Schedules

I'm not sure this is possible, but I figured I'd ask. Is there any way in AC to set up provider specific fee schedules?

We did this by enetring codes. Our private codes are P-99211, P-99212, etc. Our regular codes are 99211, 99212, does hat make sense. Yuo coud use the providers first initial followed by the billing code and change the fees accordingly.

Noami, How do you then bill using private codes?

I'm trying to set up a system where we can transfer all billing data to EZClaim, to save our biller the time that she would normally enter data manually from a super bill.

I believe it is illegal for the same provider or NPI to charge different people/insurances different rates. Check with your state and federal laws.

Leslie, in our office we are two providers who share overhead, but are legally separate business (sole-proprietorships). It is illegal for us to have the same fee schedule (it's considered collusion). Therefore, we need separate fee schedules.

Dawg, What you need to understand is that as Leslie says, it is illegal to charge different rates.
As you say, it is illegal to charge the same rates.
Sort of a "Catch-22". I think if we just do the work for free, health care costs would go down and most important, all the lawyers would be happy.

Dawg, gotcha.

You all are making my head spin.

It is illegal for me to charge different rates to different patients.

It's illegal for me and the other neurologist who work in the same office to discuss and set our rates together, as that's collusion. We are two different business entities; we don't work as a partnership or as one practice; we simply share overhead, paying our share of the rent and utilities. We are two different businesses, billing with distinctly different NPI/Tax IDs.

So, back to my original question. Is it possible to set up unique fee schedules for each provider in AC, so that it automatically populates the billing sheet when we complete an encounter?

NeuroDawg, before this gets out of hand...my post was in jest. I was making fun of the way we are regulated from all directions. IMHO what you are doing is perfectly legal, but I don't think AC can accommodate you without the type of work around suggested above.

Thanks JBS, I just wanted to clarify my situation and see if anyone could offer a work around.

By definition, two different business entities probably require 2 licenses for AC. I'm really not sure how you could have 2 different versions of AC on the same network, but that would be the "legal" thing to do and thus you could have different rates.

To your original question. Only if you export them to a differnt program (and I'm not sure about this, like EZClaims or Medisoft), perhaps that program could be set for different rates based on the provider and ignore the price assigned by AC.

Internally, within AC there is no way other than to mark up common codes as P for Dr. Peter and N for Dr. Night.

So we interface with TotalMD and the codes there are insync with the P-codes etc. You will have to talk to EZclaim to see if it will work that way??

My take on this...

What you "bill" is only related to what you receive in payment if you charge less than your "contracted" fee. How often do you get what you bill? You charge the same to each insurance company knowing you will get different reimbursement. I don't think your billing schedule is in question. The problem may arise if two docs colluded on setting their "contracted fee". I think you can use identical fee schedules. If you each bill $100 for a 9921X, your contracted rate may be 92.71 and his 93.54. No conflict.

I have to jump into this discussion. I'll simply identify myself as being an AC billing company. I frequently have to deal with this issue of different fee schedules. A physician is required to have a single retail fee schedule. Period. No fee schedule for cash patients vs. a fee schedule for insured patients. No Medicare fee schedule vs. a commercial insurance fee schedule. This is especially in focus if you a Medicare par provider.

Yes, you can give a discount to an uninsured patient if they're paying cash, BUT it CAN'T be the same discount for every patient regardless of their economic situation. Each cash discount must be negotiated by the patient at the time of payment. Why? Well, under HIPAA and federal laws covering anti-kickback rules, it's considered discriminatory to bill an insured patient and their insurer one fee while charging a lower fee to the cash patient. The solution is to have each cash patient negotiate a different discount in the same way that each insurer negotiates a discount or allowed amount from your retail fee schedule.

I strongly recommend to practices that they establish a uniform financial policy that discusses discounts for cash patients and includes a chart of discounts that start at the current federal poverty level based upon family size, and work up from that.

Why is all of this necessary? Whether you know it or not, each one of you will be audited in the next few years. Varying fee schedules is a punishable offense under the law. The Supreme Court has taken a position on this as well stating that if you accept Medicare or Medicaid, you are a federal contractor and responsible for understanding all aspects of the law that govern your agreements with government entities.

Sadly, practices are all under the microscope and federal auditors are private companies that only get paid when they find your errors. So, if you put in place solid policies that are written, consistent, and enforced internally, you're protecting yourselves. That's of utmost importance these days.

I dont see the point in charging different insurances different fees unless your billing person is trying to make it look like they are 100% collections or close to it. In the end that doesn't really matter, all that matters is that you are getting paid what you are owed.

So for example, if BCBS pays you 215.32 for a visit and for the same visit Aetna pays 201.45, some billing like to charge BCBS 216 and Aetna 202. Makes it look better.

MY billing person simply charges $450 to all the insurances and that keeps it as above the norm no matter what the fee schedules are.

I agree with Biller2 that i would have a practice of charging the same to everyone. The only rule with cash pay is that it has to be at least what you get from Medicare if you take medicare. You don't have to charge what you get from BCBS and the others. Biller2 maybe I am wrong about that but I can have a 180 fee for cash pay. If i am wrong please tell me.

thanks

ketan

Just for the record, I was not asking about different fee schedules for different payers/insurance/persons. I was asking about being able to set up a unique fee schedule for each physician using Amazing Charts. Just in case anyone was confused as to the original question on this topic.