With Medicare’s release of the 2021 fee schedule, it is imperative for providers to conduct a fee analysis to ensure they experience healthy revenue cycle management for the new year.
A simple analysis of fees and health plans’ reimbursement rates can help reveal and overcome payment inequities. Plus, there have been numerous increases to commonly used CPT codes on Medicare’s 2021 fee schedule that could result in higher reimbursements.
ACMBS recommends the following steps to conduct a fee analysis for your practice and ultimately, to ensure you’re receiving the full reimbursement:
1. Determine your most common CPT codes.
Most primary care practices derive the bulk of their revenue from office-visit, hospital and preventive-medicine codes, so the number of codes to analyze may be limited. Your list of the most common CPT codes should account for at least 75% of total practice charges.
2. Determine your reimbursement for each code.
Review the Explanation of Benefits statements from each of the top payers from step 1, and note how much they allow for your list of most common codes. Be sure to use the “allowed” amount, not the “paid” amount.
If you’re wanting to know the allowed amount for a specific procedure code that you haven’t billed yet, this information can be found under the Fee Schedule Lookup Tool.
3. Organize, analyze, and adjust accordingly.
Organize the data you have collected above into a spreadsheet. Focus first on the codes with the highest frequency and amounts, as they will yield the most return.
Based on the results of your fee analysis, you may decide to take certain actions including dropping certain health plans, limiting the number of patients with a specific insurance plan seen on your daily schedule, or stopping acceptance of new patients for a particular plan.
Due to increases in the 2021 Medicare Fee Schedule, price increases for procedures may be necessary. Annual fee analysis and taking necessary action is vital to the health of providers’ revenue management cycles. That’s why ACMBS regularly reviews clients’ most common CPTs and compares them against the new fee schedule. If necessary, ACMBS will increase the charge amount to ensure their clients receive full reimbursement.
For questions about fee analysis and maintaining the health of your practice please call ACMBS at (904) 471-9633.