Fee schedule is the agreed amount that the insurance payer is legally obligated to pay your practice for services rendered to patients. You will be paid based upon your specific contract with your insurance payers. What you may be paid could be very different from your colleagues. The fee schedule is also important for your front office or billing staff to calculate co-insurance and patient balances when your patients are paying at the time of service.
It is crucial that you document fee schedules for each CPT code in zHealthEHR in order to accurately calculate patient balances during invoice creation and monitor and audit the amounts that the insurance company is paying your practice.
Each insurance payer has their own fee schedule for what they pay a provider/practice depending on the contract. To get the fee schedule for insurance payers, you typically have to get it from their websites, contact their service center, or access a fee schedule listing tool to obtain the maximum reimbursement rate for each CPT code. Here are some of the ways to obtain a provide fee schedule from insurance payers and Medicare.
1. Visit the website of your insurance payer or contact their provider service center:
a) If you're a participating professional provider, the first way that you know how much the insurance company will pay you is a document insurance companies send you called a fee schedule. This could be a PDF or Excel file. The file may contain thousands of rows and columns that you will have to search through to find fee schedules for the CPT codes you use at your practice. To make this process easier, you will want to look for the CPT codes that you will be billing with.
b) Insurance payer - Blue Cross Blue Shield - provides a Fee Schedule Listing Tool. You can register and access it to find fee schedules for that insurance provider.
c) Aetna offers three options to access your fee schedule:
d) If you're not a participating provider with an insurance payer, you will have to join their network and sign a contract. Always read an insurer’s contract thoroughly before signing it and obtain a copy of your contract and fee schedule list.
2. Accessing Fee Schedules for Medicare
The Medicare fee schedule is part of Medicare and defines the maximum amount that Medicare will reimburse for a service. Not every code will have a reimbursement amount. Medicare posts their fee schedules on their website. They have a fee schedule look up tool that you can use to see the fee schedule for different CPT codes.
Once you've obtained fee schedule lists from insurance payers, learn how to update it for each payer in your zHealthEHR account.