Fee Schedules

Greg L Wolverton, FHIMSS, CIOArcare/KentuckyCare

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AREA of SUCCESS

What is a fee schedule?

• A record of what you charge for your services• Accurately reflect the value of those services• Includes costs to provide the services• Gives Patients, Payers, Regulators, Reviewers

a clear picture of how the organization values it’s services

Why should we do this?

• HRSA requires you to “prepare a schedule of fee or payments” that is,– consistent with locally prevailing rates or charges

and,– designed to cover the reasonable costs of operation

• Make all reasonable effort to obtain reimbursement from third party payors

• Prepare a corresponding schedule of discounts

More Reasons

• Every industry has an established fee schedule

• What if your grocer did not mark his price?• What if the hotel did not give you a rate on the front end?• The restaurant?

• PROVIDE VALUE FOR THE SERVICES YOU HAVE

How do we create our fee schedule?

What are the steps?

• Determine what individual services you will need fees.– Office Visits, Procedures, Imaging, etc.

• What does everyone else charge?– Ask around

• RBRVS – Resourced Based Relative Value Scale

•Determine your ACTUAL cost of services.– Overhead– Bad Debt– Services not grant funded

Fee Schedule Resources

• CMS Physician Fee Schedule\

• State Medicaid Fee Schedules

• CMS RBRVS

• RVU

• MGMA

RVRBS and RVU

CMS Physician Fee Schedule

RBRVS EZ-Fees Software

Create your margin

• No margin – No mission!

• Don’t leave $$ on the table

• Manage your margin as you would your mission– Appoint a team to examine your fees quarterly– Make sure you know what you get paid– Make sure you get paid what you bill

A PROPER fee schedule…

• Helps you negotiate better contracts – Better care– Better outcomes– Willingness to be up-front about your fees.

• Starting point for your Nominal Fee/Charge Schedule • Allows for predictive forecasting

Mistakes with fee schedules

• Using a Medicare rate as a base for fees

• Using what your top payer GIVES you • Using arbitrary numbers

•Not regularly reviewing your charges

• Not regularly reviewing your costs

• Using annual UDS to determine cost

Now that we created, reviewed and monitored, what’s next?

•Continuing your work

• Potential for Prosperity

• Ability

• Agility

Now that we created, reviewed and monitored, what’s next?

Rewarding Results

Minimum MaximumAverage

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The Challenge“Where are You?”

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