increase reimbursement rates

What item (no particular payer) needed on the cms-1500 can increase and improve reimbursement rates? Any help is appreciated!

Increase your prices

Most reimbursements are determine by contracted rates. The biggest mistake I have seen is setting fees as a percent of Medicare across the board. Unless you pick a really high number you may be leaving money on the table. For example, you see a patient with Green Star/Green Shield Insurance. You do a mole removal and bill your usual $200 fee. They pay you $160 (80/20% plan) with $40 due by patient. Well, you just got paid 100% of your charge. What if you charged $220? $250? At some point they would adjust your fee down to the usual and customary for that plan and indicate a writeoff for you. So you want to set your fees so that every charge gets a writeoff amount. Remember that retail prices are only paid by self-pay patients (and there are ways to give hardship discounts to self pay.) So you can charge $500 for an office visit and a few eyebrows may raise but at least you'll get the maximal reimbursement every time.

setting fees

I'll add on to this. When you do set your fees as a percentage of Medicare, be clear if you are setting your fees as a percentage of NATIONAL rates, or LOCAL rates. Medicare rates differ by location, as a function of the Geographic Practice Cost Indices (GPCI's). If your GPCI's are lower than 1, you want to set your rates as a percentage of national Medicare. If your GPCI's are higher than one, you want to set your rates as a percentage of local Medicare rates.

It is a mistake to use only RVUs to set rates. You also need to look at maximum allowed amounts from all payers, and adjust individual fees to keep from losing money.

Remember that payers will tell you they don't negotiate rates, but there are many private firms that make a living negotiating rates for private practices.