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

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Nope sounds right to me

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

,I too just adjusted my fee schedule. I use a multiplier for RVUs and previously had different multipliers for OV vs procedures. However, I didn't see much benefit in charging a high rate only to have a higher insurance adjustment. I have now calculated the multiplier to give a charge that is slightly higher than my best payer (United) allows for common procedure. This multiplier is applied for all CPTs.Previously I found some patients seemed to be bothered by a higher charge even if their insurance was just adjusting more. Do you or others see any down sides to the way I now have it set up?>> 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>