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Getting The Real Story On A Payer's Fee Schedule

You have begged and pleaded and finally received the gold mine of information -- the payer fee schedule! But, do you have the whole story about how the payer will, or won't, pay?

A complete fee schedule is more than just a list of the Current Procedural Terminology (CPT) codes and the associated contracted rate for your top procedures.

In fact, it is quite possible that many of the contracted rates listed on the fee schedule would rarely be reimbursed at the listed value.  Why?  Because there are . . .

Continue reading this article at AppealLettersOnline.com

AppealLettersOnline.com Featured Resources

AppealLettersOnline.com has new information on managed care negotiations under the Topic Contract Negotiation.  See this area for the most commonly overlooked managed care contract protections as well as suggested contract wording.  There are a number of helpful documents under Contract Negotiation including the following:

• Sample Letter for Requesting Fee Schedule Renegotiation:  This letter includes wording related to fee schedule transparency and the need for disclosure of carrier guidelines on modifiers, bundling and multiple procedure logic.

• Sample Letter for Requesting Management Care Contract Renegotiation 

• Notification of Claim Negotiation with Third Party Repricing Company:  Useful when a payer contracts with other third-party repricing companies to negotiate payment but doesn't always honor such agreements after a payment agreement is reached

• Appeal Letter Attachment Documentation:  Tracking Memos for Utilization Review/Case Management Department

Access the appeal letters at AppealLettersOnline.com

Free Webinar:  Denial Management - Conquering the Challenges

Tracking your practice's denial data often leads to surprises, challenges, and mysteries that may be sitting in the "monitor now, solve later" category.  However, denial-driven decision are the key to successful denial management and must not be ignored.

In this complimentary webinar, sponsored by Navicure, learn how to use your denial data to influence change in your organization.

Join Tammy Tipton on Thursday, September 13th at 1:00 pm EDT/ 10 am PDT for a free webinar, Denial Management: Conquering the Challenges.  During this hour, you'll hear denial management expert Tammy Tipton discuss:

• The most common sources of denials and denial avoidance techniques - specific to these problematic areas.

• Assessing your practice's internal denial data reporting process - and how that compares to other organizations.

• Incorporating denial management into your practice's workflow.

Participants can earn 1.0 Continuing Education Unit (CEU) from the American Academy of Professional Coders (AAPC) by attending the live webinar. 

Click here to register for this event.