Importance of Timely Updates of Fee Schedule in Medical Billing

Posted by Ecareindia on December 1st, 2014

One of the widely debated subjects in the US healthcare industry is how physician reimbursements are affected due to many reasons. Right from error-free medical claims processing to timely medical billing AR follow-up, so many important things help in proper physician reimbursements. In that list, timely updates of fee schedule also play a major role and it should never be overlooked. There are two kinds of fee schedules. A physician fee schedule may be defined as the list of charges predetermined by Medicare for services rendered by physicians. On the other hand, fee schedule for insurance companies is the maximum allowed charge for services rendered by Physicians. Fee schedules vary from one insurance company to another as they use different formulas to calculate. Let us see how important it is to update fee schedules on a timely manner:

The Risk of Underpayment: The problem of underpayment is highly likely if Physicians are not careful enough in quoting the right fee for the medical coding services rendered. A Provider will get lower reimbursements if he/she sends out claims with a charge that is lower than the amount allowed by the Payer. Obviously, the Payer will choose to pay the charge that was quoted by the Provider even if he deserves a higher reimbursement. Determining Fee Schedules:

· Detailed Cost Analysis: Doing a cost analysis by self study or with the help of a consultant can help determine the right fee schedule. The best way to determine fee schedules is by breaking down the costs into units of work. This way, Physicians can assign their share of overhead costs along with actual costs for each medical coding service rendered.

· Medicare Method: Another simple way is to calculate with the Medicare fee schedule as the base. Medicare updates its fee schedules every year, so Providers must keep their fee schedules updated accordingly for proper reimbursements. To avoid underpayment, it is good to multiply the Medicare fee schedule by 1.5 or 2 times for each CPT code while billing Medicare. The same process can be followed for commercial payers which have their fee schedule typically as a percentage of Medicare’s. This way, Providers can avoid underpayments.

Importance of Timely Updates: As mentioned earlier, it is highly essential that Providers as well as US medical claims processing companies update the fee schedules in their billing systems, whenever a revision happens. If the wrong charges are applied, then Physicians may get underpaid or penalized for quoting a higher fee. As Providers get to see patients with diversified insurance carriers, maintaining separate fee schedules for each Payer may seem a tough task. In that case, they can get help from offshore medical billing companies.

e-care is one of the reputed offshore medical billing companies in India that has been maintaining and updating varied fee schedules for its clients while providing exceptional medical coding services.

About e-care India:

e-care India has 14 years of experience in the industry. e-care’s 3 offshore medical billing delivery centers have been providing end-to-end medical billing, AR follow-up services seamlessly to its clients. To know more about e-care and its services, log on to

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