As the new year quickly approaches, we all await the “final” Medicare fee schedule. We are familiar with the routine. Each November a fee schedule is published, but it is pending based upon Congress and the supposed required budget reductions. The large cuts seem to eventually get overturned, producing a much different “final” schedule than seen in November.
So while you are waiting to see how your Medicare will reimburse in 2013, take time to review your Commercial payer contracts and fee schedules.
Some contracts are base on Medicare rates, but are typically renewed every few years, not annually. Depending on the wording of your contract, if the reimbursement is based on a particular year's Medicare fees, then you may be due for an increase adjustment.
For contracts that have their own payer determined fee schedule, you should review those to see when the rates were last adjusted by the payer. It may be time to contact your Provider Relations Representative and discuss the potential for any upcoming changes in reimbursement.
If your specialty in is high demand, you may also use this as a factor in negotiating higher fees from the payer.
Besides just being familiar with your payer fee schedules, it is integral to the health of your practice to confirm that you are being paid accordingly.
To do this you could be “old school” and compile a sampling of EOB's from your contracted payers, comparing the allowed amounts to the fee schedules to check for discrepancies. This of course will be a laborious and time consuming project.
If you have medical billing software such as Iridium Suite, you could let the system do it for you with the Reimbursement Analyzer Report. The report data indicates the expected reimbursement versus the actual payments, indicating those that are lower than the contracted rate and poor faith contracting on the part of the payer. The results can demonstrate a consistent and possibly an intentionally inappropriate reimbursement pattern. This report can also reveal problems where an opportunity to improve billing can occur.
Iridium Suite also allows the report to be scheduled to run automatically, emailing the results to any indicated party. This type of automation is one of the many features that makes this one of the best medical billing softwares available today.