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Fee Schedules
Greg L Wolverton, FHIMSS, CIOArcare/KentuckyCare
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Ability to Generate Solutions
Potential for Prosperity
AREA of SUCCESS
What is a fee schedule?
• A record of what you charge for your services• Accurately reflect the value of those services• Includes costs to provide the services• Gives Patients, Payers, Regulators, Reviewers
a clear picture of how the organization values it’s services
Why should we do this?
• HRSA requires you to “prepare a schedule of fee or payments” that is,– consistent with locally prevailing rates or charges
and,– designed to cover the reasonable costs of operation
• Make all reasonable effort to obtain reimbursement from third party payors
• Prepare a corresponding schedule of discounts
More Reasons
• Every industry has an established fee schedule
• What if your grocer did not mark his price?• What if the hotel did not give you a rate on the front end?• The restaurant?
• PROVIDE VALUE FOR THE SERVICES YOU HAVE
How do we create our fee schedule?
What are the steps?
• Determine what individual services you will need fees.– Office Visits, Procedures, Imaging, etc.
• What does everyone else charge?– Ask around
• RBRVS – Resourced Based Relative Value Scale
•Determine your ACTUAL cost of services.– Overhead– Bad Debt– Services not grant funded
Fee Schedule Resources
• CMS Physician Fee Schedule\
• State Medicaid Fee Schedules
• CMS RBRVS
• RVU
• MGMA
RVRBS and RVU
CMS Physician Fee Schedule
RBRVS EZ-Fees Software
Create your margin
• No margin – No mission!
• Don’t leave $$ on the table
• Manage your margin as you would your mission– Appoint a team to examine your fees quarterly– Make sure you know what you get paid– Make sure you get paid what you bill
A PROPER fee schedule…
• Helps you negotiate better contracts – Better care– Better outcomes– Willingness to be up-front about your fees.
• Starting point for your Nominal Fee/Charge Schedule • Allows for predictive forecasting
Mistakes with fee schedules
• Using a Medicare rate as a base for fees
• Using what your top payer GIVES you • Using arbitrary numbers
•Not regularly reviewing your charges
• Not regularly reviewing your costs
• Using annual UDS to determine cost
Now that we created, reviewed and monitored, what’s next?
•Continuing your work
• Potential for Prosperity
• Ability
• Agility
Now that we created, reviewed and monitored, what’s next?
Rewarding Results
Minimum MaximumAverage
Ave
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Max
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The Challenge“Where are You?”
Ability to Generate SolutionsAbi
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