Re: Re: 2012 Charge Master - procedural and E&M codes, et al - internal logic to fees

[Guest guest]

I have just started billing for myself....fun challenge! ( I am going on a week straight of daily migraines!) Do I need to find or assign units to every code I submit?? I have just been putting ICD 9 codes and my charge.Thank s!Dannielle Harwood, MDTo: Sent: Wed,

January 4, 2012 4:29:12 PMSubject: Re: 2012 Charge Master - procedural and E & M codes, et al - internal logic to fees

The problem I have occasionally run into is that various payers will not play by the RVU rules and will pay way less for some codes and more for others. In order for it to balance out, you have to capture all the dollars for all codes. So just be careful that you're not leaving money on the table for any codes by using an across-the-board multiplier.

Yes, this pushes us to make ridiculously high fee schedules. But apparently we have come to the conclusion that these games are how we should finance health care.

Haresch

www.onefamilydoctor.com

> >

> > I am in the process of revamping my Charge Master.

> >

> > How have others revamped their Charge Master?

> > % of Medicare Fees -- ie Medicare allows $10 -- you charge 200% of Medicare

> > or $20 or 150% of Medicare or $15

> > Multiplier x RVU's for a CPT

> > Other?

> >

> > When my previous group dissolved, I took the charges from the most common

> > codes and transferred them into our new Charge Master.

> > These old charges were based upon that groups charge list that was updated

> > over the years.

> > I'm not sure that there was ever any specific logic to the charges -- ie %

> > of Medicare or multiplier on RVU's, etc.

> > But it was what it was.

> >

> > Over the years, I would increase the Charge Master by a % of last year's

> > rates and create a new Charge Master for the current year.

> >

> > This year, I decided to bring some internal logic to the charges and create

> > a 2012 Charge Master that is a % of a 2011 Medicare Fee Schedule in my EMR.

> > The idea was to take a 99213, figure out what I should be charging - then

> > multiply the 2011 Medicare Rate by a multiplier to equal that new 99213

> > rate.

> > Then multiply ALL the Medicare Fee Schedule in my EMR by that same

> > multiplier to create the new 2012 Charge Master.

> >

> > Interestingly, when I do this, the fees I charged for Procedures (ie punch

> > biopsy, colposcopy, etc) went down -- despite a pretty significant increase

> > in my E & M visit code fees.

> >

> > I guess this means (at least based upon Medicare logic), I was overcharging

> > for my procedural codes.

> >

> > I'm hoping that my increase in E & M codes will make up for a drop in

> > Procedural Code fees -- but that in the end, there will be some internal

> > logic to what I am charging.

> >

> > I know for many of you, what you charge doesn't matter -- it's what the

> > insurance will pay.

> > We are somewhat unique in our Valley in regards to our contracts and what

> > we charge does make a difference in what is paid - up to a point.

> >

> > Thoughts?

> >

> > Locke, MD

> >

>

[Guest guest]

Huh? Ask and I will be happy to answer, as I'm sure will others. Who are you billing, for starters? Sent from my iPad

I have just started billing for myself....fun challenge! ( I am going on a week straight of daily migraines!) Do I need to find or assign units to every code I submit?? I have just been putting ICD 9 codes and my charge.Thank s!Dannielle Harwood, MDTo: Sent: Wed,

January 4, 2012 4:29:12 PMSubject: Re: 2012 Charge Master - procedural and E & M codes, et al - internal logic to fees

The problem I have occasionally run into is that various payers will not play by the RVU rules and will pay way less for some codes and more for others. In order for it to balance out, you have to capture all the dollars for all codes. So just be careful that you're not leaving money on the table for any codes by using an across-the-board multiplier.

Yes, this pushes us to make ridiculously high fee schedules. But apparently we have come to the conclusion that these games are how we should finance health care.

Haresch

www.onefamilydoctor.com

> >

> > I am in the process of revamping my Charge Master.

> >

> > How have others revamped their Charge Master?

> > % of Medicare Fees -- ie Medicare allows $10 -- you charge 200% of Medicare

> > or $20 or 150% of Medicare or $15

> > Multiplier x RVU's for a CPT

> > Other?

> >

> > When my previous group dissolved, I took the charges from the most common

> > codes and transferred them into our new Charge Master.

> > These old charges were based upon that groups charge list that was updated

> > over the years.

> > I'm not sure that there was ever any specific logic to the charges -- ie %

> > of Medicare or multiplier on RVU's, etc.

> > But it was what it was.

> >

> > Over the years, I would increase the Charge Master by a % of last year's

> > rates and create a new Charge Master for the current year.

> >

> > This year, I decided to bring some internal logic to the charges and create

> > a 2012 Charge Master that is a % of a 2011 Medicare Fee Schedule in my EMR.

> > The idea was to take a 99213, figure out what I should be charging - then

> > multiply the 2011 Medicare Rate by a multiplier to equal that new 99213

> > rate.

> > Then multiply ALL the Medicare Fee Schedule in my EMR by that same

> > multiplier to create the new 2012 Charge Master.

> >

> > Interestingly, when I do this, the fees I charged for Procedures (ie punch

> > biopsy, colposcopy, etc) went down -- despite a pretty significant increase

> > in my E & M visit code fees.

> >

> > I guess this means (at least based upon Medicare logic), I was overcharging

> > for my procedural codes.

> >

> > I'm hoping that my increase in E & M codes will make up for a drop in

> > Procedural Code fees -- but that in the end, there will be some internal

> > logic to what I am charging.

> >

> > I know for many of you, what you charge doesn't matter -- it's what the

> > insurance will pay.

> > We are somewhat unique in our Valley in regards to our contracts and what

> > we charge does make a difference in what is paid - up to a point.

> >

> > Thoughts?

> >

> > Locke, MD

> >

>

[Guest guest]

I learned it last year when I started a practice. Does your billing company have online seminars? I joined a series of my billing company's seminars, some topic more than once. After a month, I finally got a clue. Now I could say it is easy and I am showing my assistant how to post the statement, etc.

 There were questions and answers on the IMP website regarding these. I made a mast fee schedule for your most often used CPT codes: 99203, 99204, etc.  Your ICD 9 codes are to support CPT codes.

 Wen Liang, MDSan Mateo, CA 

 

Huh?  Ask and I will be happy to answer,  as I'm sure will others.   Who are you billing,  for starters? Sent from my iPad

 

I have just started billing for myself....fun challenge! ( I am going on a week straight of daily migraines!)  Do I need to find or assign units to every code I submit?? I have just been putting ICD 9 codes and my charge.

Thank s!Dannielle Harwood, MD

To:

Sent: Wed,

January 4, 2012 4:29:12 PMSubject: Re: 2012 Charge Master - procedural and E & M codes, et al - internal logic to fees

 

The problem I have occasionally run into is that various payers will not play by the RVU rules and will pay way less for some codes and more for others. In order for it to balance out, you have to capture all the dollars for all codes. So just be careful that you're not leaving money on the table for any codes by using an across-the-board multiplier.

Yes, this pushes us to make ridiculously high fee schedules. But apparently we have come to the conclusion that these games are how we should finance health care.

Haresch

www.onefamilydoctor.com

> >

> > I am in the process of revamping my Charge Master.

> >

> > How have others revamped their Charge Master?

> > % of Medicare Fees -- ie Medicare allows $10 -- you charge 200% of Medicare

> > or $20 or 150% of Medicare or $15

> > Multiplier x RVU's for a CPT

> > Other?

> >

> > When my previous group dissolved, I took the charges from the most common

> > codes and transferred them into our new Charge Master.

> > These old charges were based upon that groups charge list that was updated

> > over the years.

> > I'm not sure that there was ever any specific logic to the charges -- ie %

> > of Medicare or multiplier on RVU's, etc.

> > But it was what it was.

> >

> > Over the years, I would increase the Charge Master by a % of last year's

> > rates and create a new Charge Master for the current year.

> >

> > This year, I decided to bring some internal logic to the charges and create

> > a 2012 Charge Master that is a % of a 2011 Medicare Fee Schedule in my EMR.

> > The idea was to take a 99213, figure out what I should be charging - then

> > multiply the 2011 Medicare Rate by a multiplier to equal that new 99213

> > rate.

> > Then multiply ALL the Medicare Fee Schedule in my EMR by that same

> > multiplier to create the new 2012 Charge Master.

> >

> > Interestingly, when I do this, the fees I charged for Procedures (ie punch

> > biopsy, colposcopy, etc) went down -- despite a pretty significant increase

> > in my E & M visit code fees.

> >

> > I guess this means (at least based upon Medicare logic), I was overcharging

> > for my procedural codes.

> >

> > I'm hoping that my increase in E & M codes will make up for a drop in

> > Procedural Code fees -- but that in the end, there will be some internal

> > logic to what I am charging.

> >

> > I know for many of you, what you charge doesn't matter -- it's what the

> > insurance will pay.

> > We are somewhat unique in our Valley in regards to our contracts and what

> > we charge does make a difference in what is paid - up to a point.

> >

> > Thoughts?

> >

> > Locke, MD

> >

>