Sometimes, it is what it is. And that applies to certain fees in your fee system. If you want to play in the sandbox of certain payers, you accept that regulated fee. This is different from a contracted fee in which you have a choice to participate. With regulated fees, if you accept the patient,…
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Because so much of billing compliance relates to the agreement (or lack thereof) signed by a provider of service, there is no more important document than the provider’s agreement with a payer. These contracts are often signed in haste when the practice is young, and sometimes are updated with only a short email that the…
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Practice Decision Making Matrix The decision for a provider or practice to join a third-party network is a very personal one. But it must also be a business decision. In addition to being willing to accept a discounted fee when treating members of the plan, the practice must be sure that the amount to be…
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Download Support Tool This helpful Support Tool provides a visual flow of how contracted discounts work between the provider, the patient, and the payer. Often, contractual agreements are made by doctors with payers without full knowledge of the obligations and expectations for doing so. Or a full understanding of the fee agreed upon. Download, save…
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HMO, PPO, and POS Plans When commercial health insurance began, it was not as complicated as it is today. Pre-1990, for example, managed care plans were rare. Most people had fee-for-service plans or indemnity insurance. This type of plan offered the choice to go to any doctor and if the doctor accepted your insurance, you…
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Download Support Tool At its very core, the practice fee system can be explained in a series of “either/or” scenarios. It starts by explaining that all the fees in our practice are either “actual” fee or “discounted” fees. From there, discounted fees are either “imposed” or “elective”. A keen understanding of this concept is essential…
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