Author Archives: medrevinc

Medical Revenue: Planning Your Service Charges with the Medicare Physician Fee Schedule in Mind

The Medicare Physician Fee Schedule (MPFS) applies to healthcare provider services such as office visits, lab work, types of therapy, surgical procedures and more. It gives providers guidelines on what Medicare will cover for services and how much it will reimburse the provider.

Medicare Physician Fee Schedule Rates

doctor calculating the physician fee for his practice

The rates are determined based on input from representatives of health care professional associations and societies, such as the American Medical Association. The components used to determine the rates are:

  • The amount of time, technical skill, medical judgement, and effort needed
  • How much it costs the practice for equipment, supplies, or the time of an assistant
  • Professionally liability

The Centers for Medicare and Medicaid Services (CMS) decide the final rate for each procedure code, and then it is multiplied by a dollar amount to determine the national average fee. Finally, rates are adjusted according to where a provider is located. You can find the rates for your local area by going to the CMS Physician Fee Schedule Look-Up site. Urban areas and cities have payment rates that are five to 10 percent above the national average, with rural areas offering lower rates.

The MPFS includes both facility and non-facility rates. Services provided in a doctor’s own office results in a higher Medicare fee because the doctor is paying for overhead and equipment costs.

When’s the last time you compared your service charge?

Have you compared your service charges to the current allowed payments from Medicare or other carriers? A large volume of practices do not review the current Medicare Physician Fee Schedule, which the majority of health insurance carriers use as a guideline for what they will pay for a service.

If the physician’s charge is below the amount the carrier would have paid, they would lose income. As an example, if the physician charged a carrier 80.00 for a service, but the carrier’s contract is 95.00, the carrier will only pay what has been submitted (80.00), but the physician has lost 15.00. If the physician charged 120.00 for the service, the carrier will pay at their contracted amount of 95.00. The balance cannot be passed on to the patient.

Let the professionals at Medical Revenue Associates, Inc. help you manage your accounts receivable. We have years of experience and the expertise necessary to provide you with a personalized medical billing service.

Give us a call at 215-497-1001 to learn more.

Credentialing Services: Adding or Removing a Physician from Your Carrier Profiles

Being a practice within a managed care carrier network or multiple carrier networks means inevitably having to add or remove a physician from your carrier profile. This process involves an application process (completing the 30-page Council for Affordable Quality Healthcare (CAQH) questionnaire) for a specific network and must be completed whenever there is a provider…

Credentialing Services: Benefits of Joining a Carrier Network

Taking the time to join an established provider network can sound like a huge drain on office resources but doing so can be a major benefit for healthcare providers in the practice, as well as your patients. In-network vs. out-of-network Most patients with insurance have the option of choosing a doctor or healthcare provider that…

What to Know About Credentialing and How Long Does the Process Take?

Being a credentialed practice helps you get “in-network” with insurance companies. Patients will almost always look for providers that readily accept their insurance, as it usually more cost-effective for them and makes the payment process easier. However, becoming a credentialed practice is not necessarily a brief and easy thing to do. The process usually takes…

Questions to Ask Your Medical Billing Staff to Maximize Patient Collections

The goal of any medical billing department is to collect the maximum amount of patient billing. So how do you make sure your staff is doing what they can to maximize revenue for your practice? Is the process clear and straightforward? Creating and documenting a thorough collection process ensures each staff member knows their responsibilities.…

SGR (Sustainable Growth Rate) delays – again!

Why isn’t Congress supporting our healthcare providers? Every year we go through this agonizing time frame of facing a 20% cut in Medicare payments, while Congress constantly bypasses their responsibility. Congress can’t be penalized for their lack of appropriate actions, so they do what is in their best interests. Typical political selfishness. Our government expects our healthcare providers…