Billing for Dollars

I've been spending a lot of time billing and trying to catch up on submitting bills for visits from 1, 2, even 3 months ago. I use Medrium, which I've found to be very helpful. I will write a little review of it later.

A couple of days ago I got my first two checks from patients who have insurance. Their insurers didn't cover the entire charge for their visit, so I sent them a bill. I've been setting my fees higher than Medicare's, using the rationale that Medicare's fees are the "baseline". I remember reading somewhere that you should set your fees higher because each insurer has their own individual "allowed amount" for each E&M code, and if you undercharge them, you could be losing out on some money.

For instance, a level 3 visit for a new patient (code: 99203) would be paid $104.46 by Medicare. Blue Cross's allowed amount is 101.02. My stated amount is $155. Unfortunately, if the patient's deductible hasn't been met yet, then the patient gets charged $155.

Another example, a preventive health visit for someone aged 18-39 (code: 99385). Medicare doesn't pay for preventive health visits so nothing to compare with there. I found some other fee schedules on the internet and chose a fee of $165. Blue Cross's "allowed amount": $165. That suggests to me that this is not their highest allowed amount, and I probably could have charged for more money. In this patient's case, however, his insurance only pays for 60% of the visit. So it's kind of a game to figure out how much money to charge to maximize reimbursement from the insurers without gouging the patients.

Yesterday I received a letter for denial of payment for a sports physical for a teenaged boy because their coverage does not include preventive health visits. I resubmitted it as a level 2 new patient visit ($105) because otherwise his family would be responsible for the entire charge of the sports physical ($160). I'd rather have the insurer pay for part of the visit, even if I get a lower total amount. I think the patient's parents would appreciate that, too.

I'm getting ready to take a week off, as my family will be going out of town. In the past, I've never been busy enough to even worry about patients calling while I was away. This time, I plan to change my answering machine message to let callers know that I am gone for the week, but they can still reach me by cellphone. Plus, I made arrangements with a couple of local FPs who agreed to let me give out their names and phone numbers if there are any patients who need to see someone before I get back.