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Revenue Cycle Management : Billing & Coding Compliance

Billing & Coding Compliance



 The importance of establishing a defensible and reasonable fee schedule has been a point of emphasis with the AMA and specialty associations for the past several years.  The ability to defend fees against potential payers, patients and local competitors is a vital consideration when devising your practice’s fee schedule. 

As patients continue to incur more out-of-pocket healthcare costs, the cost of services is becoming a more prominent factor when choosing a physician.  The fee schedule should be viewed as a component of the overall marketing plan for the practice, and therefore needs to be set with consideration of industry standards, socio-economics of a locale, and associated practice expense.  Fee schedules updated annually with these principles in mind will promote:
  • Improved analysis of reimbursement rates through assured proportionality and  consistency in how fees are set.
  • Empowered staff able to make informed assessments of payment rates as payer explanations of benefits are processed and, to offer discounted rates to the uninsured that are consistent and fair to both parties.
  • Improved position in payer negotiations through demonstration of a well thought out, logical, and defensible fee schedule. 
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