Fee Schedules Greg L Wolverton, FHIMSS, CIO Arcare/KentuckyCare

Ability to Convert Solutions into Reality Ability to Generate Solutions Potential for Prosperity AREA of SUCCESS

What is a fee schedule? A record of what you charge for your services Accurately reflect the value of those services Includes costs to provide the services Gives Patients, Payers, Regulators, Reviewers a clear picture of how the organization values it’s services

Why should we do this? HRSA requires you to “prepare a schedule of fee or payments” that is, –consistent with locally prevailing rates or charges and, –designed to cover the reasonable costs of operation Make all reasonable effort to obtain reimbursement from third party payors Prepare a corresponding schedule of discounts

More Reasons Every industry has an established fee schedule What if your grocer did not mark his price? What if the hotel did not give you a rate on the front end? The restaurant? PROVIDE VALUE FOR THE SERVICES YOU HAVE

How do we create our fee schedule?

What are the steps? Determine what individual services you will need fees. – Office Visits, Procedures, Imaging, etc. What does everyone else charge? – Ask around RBRVS – Resourced Based Relative Value Scale Determine your ACTUAL cost of services. – Overhead – Bad Debt – Services not grant funded

Fee Schedule Resources CMS Physician Fee Schedule\ State Medicaid Fee Schedules CMS RBRVS RVU MGMA

RVRBS and RVU

CMS Physician Fee Schedule

RBRVS EZ-Fees Software

Create your margin No margin – No mission! Don’t leave $$ on the table Manage your margin as you would your mission – Appoint a team to examine your fees quarterly – Make sure you know what you get paid – Make sure you get paid what you bill

A PROPER fee schedule… Helps you negotiate better contracts – Better care – Better outcomes – Willingness to be up-front about your fees. Starting point for your Nominal Fee/Charge Schedule Allows for predictive forecasting

Mistakes with fee schedules Using a Medicare rate as a base for fees Using what your top payer GIVES you Using arbitrary numbers Not regularly reviewing your charges Not regularly reviewing your costs Using annual UDS to determine cost

Now that we created, reviewed and monitored, what’s next? Continuing your work Potential for Prosperity Ability Agility

Now that we created, reviewed and monitored, what’s next?

Rewarding Results

MinimumMaximumAverage Maximum The Challenge “Where are You?” Ability to Generate Solutions Ability to Convert Solutions into Reality