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

[Guest guest]

HI,

  I use 200% of the rates; but of course paid whatever the insurance wants to pay me..

The range is so bizarre.

Debra

 

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>

[Guest guest]

My PM software defaults most of these details. Every CPT code defaults to a unit

of 1 unless I change it. Then I link ICD-9 codes to the CPTs. The software puts

in the charge from a charge list. What software are you using?

Haresch

> > >

> > > 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 am using Kareo. It also defaults to a unit of 1...and since I have no idea what the unit should be I have just been leaving it alone.I entered a fee schedule and linked it to the CPT codesThank you!DannielleTo: Sent: Thu, January 5, 2012 7:04:32 PMSubject: Re: 2012 Charge Master - procedural and E & M codes, et al - internal logic to fees

My PM software defaults most of these details. Every CPT code defaults to a unit of 1 unless I change it. Then I link ICD-9 codes to the CPTs. The software puts in the charge from a charge list. What software are you using?

Haresch

> > >

> > > 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]

So 1 unit will almost always be right. It just means that you did one procedure

(or E & M). You'll only change it if you do more than one of something, e.g. you

give 3 vaccines to an adult, then you bill 1 unit of 90471 and 2 units of 90472.

Haresch

> > > >

> > > > 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]

So if i do an EKG and an office visit is that 2 units?

Dannielle

To: Sent: Fri, January 6, 2012 7:58:22 PMSubject: Re: 2012 Charge Master - procedural and E & M codes, et al - internal logic to fees

So 1 unit will almost always be right. It just means that you did one procedure (or E & M). You'll only change it if you do more than one of something, e.g. you give 3 vaccines to an adult, then you bill 1 unit of 90471 and 2 units of 90472. Haresch> > > >> > > > 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]

It is 1 unit of 93000 and 1 unit of 9921x. Pratt

 

So if i do an EKG and an office visit is that 2 units?

 

Dannielle

To:

Sent: Fri, January 6, 2012 7:58:22 PMSubject: Re: 2012 Charge Master - procedural and E & M codes, et al - internal logic to fees

 

So 1 unit will almost always be right. It just means that you did one procedure (or E & M). You'll only change it if you do more than one of something, e.g. you give 3 vaccines to an adult, then you bill 1 unit of 90471 and 2 units of 90472.

Haresch> > > >> > > > 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]

For le, another example of when the # of units is more than 1: If you

give 60 mg of ketorolac IM in the office, the CPT code J1885 specifies that it

is for 15 mg of ketorolac, so you have given 4 units of the medication. You also

bill for the therapeutic injection of the medication, with CPT 96372, which is

different than the vaccination code. If you give 2 IM injections that day, such

as when I give ketorolac and metoclopromide for an intractable migraine, you

bill 2 units of 96372. ---Sharlene

> > > > >

> > > > > 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]

Makes sense!\Thank you!To: Sent: Sat, January 7, 2012 5:18:55 PMSubject: Re: 2012 Charge Master - procedural and E & M codes, et al - internal logic to fees

For le, another example of when the # of units is more than 1: If you give 60 mg of ketorolac IM in the office, the CPT code J1885 specifies that it is for 15 mg of ketorolac, so you have given 4 units of the medication. You also bill for the therapeutic injection of the medication, with CPT 96372, which is different than the vaccination code. If you give 2 IM injections that day, such as when I give ketorolac and metoclopromide for an intractable migraine, you bill 2 units of 96372. ---Sharlene

> > > > >

> > > > > 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

> > > > >

> > > >

> > >

> >

>