From Care to Compensation, Part 2 -- From Claim to Billing
From Care to Compensation, Part 2 -- From Claim to Billing
The entire billing and payment process is controlled by three all-encompassing rules:
So, how much should you charge for your services? There are more than 500 occasionally reported CPT codes that each need an assigned price. The setting of professional fees has several determinants:
There are national and regional sources to assist in setting fees, including Medicare's "Fee Schedule and Relative Value Units" and various commercially available fee sources. The free service www.FAIRHealthconsumer.org is a good place to start. Much can be said about rational fee setting, but most important is that fees must generate sufficient revenue to cover practice costs — including physician salaries — and be reasonable for the market.
Pricing
The entire billing and payment process is controlled by three all-encompassing rules:
No one pays you what you charge, they pay you what you have negotiated.
Everyone wants to pay you much less than you have negotiated.
Everyone wants to take forever to pay you at all.
So, how much should you charge for your services? There are more than 500 occasionally reported CPT codes that each need an assigned price. The setting of professional fees has several determinants:
Market value — what others are commonly charging and being paid in your geo-economic area.
Intrinsic value — what you feel is fair for the associated work.
Relative value — how the complexity of the service compares to other charged services.
PR value — what will be acceptable to your patients and your hospital administrator.
There are national and regional sources to assist in setting fees, including Medicare's "Fee Schedule and Relative Value Units" and various commercially available fee sources. The free service www.FAIRHealthconsumer.org is a good place to start. Much can be said about rational fee setting, but most important is that fees must generate sufficient revenue to cover practice costs — including physician salaries — and be reasonable for the market.
