Eye-Opening Facts about Fee Schedule Management

03.28.2020 | Jason Gillespie

Many small practices and healthcare providers struggle to manage fee schedules. We sat down with some industry experts to find out exactly what the problems are. With these four points in mind, you can get on top of insurance fee schedules for your practice.

1. Healthcare providers work with up to 20 different fee schedules

One reason why insurance fee schedules are so difficult to manage is that there are so many of them. Each insurance provider has their own fee schedule. And practices need to understand each individual schedule so that they ensure they are being paid their contracted rate.

Our experts estimated that the average doctor has patients with up to 20 different insurance providers and even more plans underneath each insurance. Half of those would be commercial providers or insurance companies, while the rest are AHCCCS plans and government coverage.

So as well as separate schedules, practices have to understand the separate guidelines for commercial and AHCCCS insurance plans.

2. Insurance fee schedules change constantly

Insurance fee schedules are also a “moving target,” our panel explained. Each one of those 20 insurances regularly updates their fee schedule. That makes it even more difficult for practices to keep up with fee schedule management. Imagine 20 insurances changing their insurance fee schedules all at once. How would you keep your system up to date?

3. Most practices don’t record fee schedules…

Even more surprisingly, many practices do not even attempt to stay on top of insurance fee schedules. A significant number simply never record fee schedules in their Electronic Records Management systems.

So, although insurance fee schedules are made available by insurances, many practices do not have that information at their fingertips. This makes the process of fee schedule management far more complex and time-consuming.

4. …and practices don’t check payments for errors

Electronic Records Management is designed to make insurance fee schedule management more efficient, with fewer errors and less effort involved. But astonishingly, many practices do not just fail to record fee schedules. They do not track the payments they receive, either.

Because the world of insurance fee schedules is so complicated, it is always worth checking that payments are correct. Even more so if a provider has recently updated their fee schedules. However, our industry insiders know of many practices that were missing out on substantial payments — because they just never checked.

So what is the solution to these common problems? Every practice, of any size, can benefit from a comprehensive electronic system to manage their insurance fee schedules.

Look for a system that prioritizes information security with experts on hand to advise you on insurance codes and schedules. With the right system, you can keep track of multiple insurance providers and fee schedule changes. You will be able to track when payments arrive and whether they match your expectations.