Updating Your Charge Fee Schedule

Making yearly updates to your charge fee schedule is one of the most important things a provider can do to ensure the collection of an appropriate amount for services.

Rates change over the years due to Amendments, Proprietary Market Fee Schedules or CY Medicare-Based Fee Schedules.

Payer Reimbursement Pitfalls

  • "Evergreen" Clause

Most contracts contain an evergreen clause, which is a fancy way of saying that the contract goes on and on until something triggers renegotiation and/or termination. The contract is automatically renewed unless one or both of the parties modify or terminate it. 

  • % of Billed Charges (BC)

Contracts that are primarily based on a percent of billed charges (BC) will be devastating if, for example: your charges are at 150% of CY Medicare and the Agreement pays 50% of billed charges - you are getting paid 75% of CY Medicare.

  • Payer Amendments

Oftentimes an agreement will state that the payer has the right to amend the contract without prior written notice. Reject any language which gives the payer unilateral amendment rights.

If the agreement requires the payer to provide notice of the amendment, remember, usually; “Following (30) days written notice. Failure to object constitutes agreement.”

  • "Lesser of" Language

All too often, practices have certain codes that fall below contract rates and almost all contracts have a “lesser of billed charges (BC) or contract rate” provision. Meaning, if your contract rate is $100 and your charge is $50 - you just lost $50 and can not get it back!
The primary mission of CodeToolz is to help medical providers increase their revenue. It’s as simple as that.
Dana R. Bellefountaine Jr.
Phone: (877) 464-3005