Medical Billing: Choosing the Right Fee Schedule

Medical Billing: Choosing the Right Fee Schedule

A good friend of mine is an ophthalmologist starting his own practice. He called me this week with questions on a variety of medical billing topics, including payer contracting and fee schedules. He asked me what I thought was the ideal fee schedule: 1x Medicare rates? 2x Medicare? 3x Medicare?

This is a question that we get all the time. In truth, it’s a delicate balance. On the one hand, we usually advocate for a higher fee schedule in order to maximize reimbursement. On the other hand, patients today are hypersensitive to the rising costs of healthcare and it feels like not a month goes by without an article in the newspaper about a patient who received an “outrageous” or “obscene” medical bill.

In most cases, the fee schedule you select does not actually matter. Most physicians are contracted with most payers, which means that they will accept their allowed amounts even if their fee schedules are much higher. However, with out of network payers and self-pay patients the fee schedule can come into play as in these cases the reimbursement will often be at the full billed amount or a percentage of the billed amount.

It's for these cases that we usually recommend a higher fee schedule. And if you’re worried about patients complaining, ask them how much they pay their plumber or attorney and remind them that you trained for 20 years.

To learn more about choosing the right fee schedule, feel free to reach out to us and we would be more than happy to help.

Ori Kanefsky

Chief Operating Officer
Nexus Healthcare Solutions