“Healthcare is a business and business is bottom line driven, the bottom line of healthcare is driven by the medical codes” (Meyer, 2007).
Fee Schedules & Billing Forms:
Never has it been so important to begin the end of year updates to your clinic’s fee schedules, superbills and hospital chargemasters timely. In 2013-2014 and beyond, in the wake of CMS quality initiatives, e.g., the Physician Quality Reporting System (PQRS), Hospital Quality Initiative (HQI), the Accountable Care Organization Pay-for-Performance (P4P), and with ICD-10-CM/PCS on the horizon updating fees, forms and your medical billing software by January 1 is critical to your bottom line.
Tips for Optimizing:
To avoid unnecessary denials, and potential payment errors, or missed quality reporting opportunities, all claims should be filed with current year CPT, ICD-9, and HCPCS codes, using current year coding and reporting conventions. There should be only one standard provider fee schedule for your business in your practice management software, which is effective January 1 of each year.
Click here for a presentation of tips for optimizing your fee schedule for 2013 and beyond: The Birds, the Bees and Your Fees!
CMS. (2012) Physician Fees. Resource Based Relative Value Scale. http://www.cms.gov/apps/physician-fee-schedule/
CMS. (2012) Outpatient Perspective Payment System. Ambulatory Payment Classifications. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html
CMS (2012) Inpatient Perspective Payment System. Medical-Severity Diagnostic Related Groups. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/
CMS. (2012). Roadmap for Quality Measurement in the Traditional Medicare Fee-for-Service Program. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/QualityMeasurementRoadmap_OEA1-16_508.pdf
Meyer, Michael A., Meyer, Madeline A. (2007-2012) Tier I. Module V. Medical Reimbursement. Medical Coding Preparatory® 5th Edication. eBook Self-Publication, 2012.