Practice Management

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  • 1.  Fee Schedule Requests

    Posted 05-29-2020 14:52
    Happy Friday all!

    I have radiology departments who will occasionally ask us for our fee schedules so they can quote fees to patients.  As you all know, this is not an easy task.  We have one commercial fee schedule that we bill out for all services, but we participate with 99.9% of the payers, all at different allowed amounts.  Giving out the single commercial schedule to our departments would not serve their purpose or help the patient in their quest for accurate information.  Giving out all of our various alloweds would likely violate some the confidentiality provisions in certain payer agreements.  In addition, I am not confident the information would be relayed accurately to the patient, or with the appropriate disclaimers about additional views, contrast, etc.  It is for those reasons that we limit the staff in our office who are allowed to give quotes.

    With all of the above being said, has anyone found a solution for this vexing issue?  One which would satisfy our patients and hospitals, yet allow us to remain compliant with our agreements and ensure control over the message and information relayed?

    Thank you,

    ------------------------------
    [Sheila] [Witous] [MBA, CPA, CGMA]
    [Chief Administrative Officer]
    [Radiology, Inc.]
    [South Bend] [IN]
    [(574) 258-1100 ext. 205]
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  • 2.  RE: Fee Schedule Requests

    Posted 05-29-2020 16:03

    We are also asked on occasion for our fee schedule from our associated hospitals and release it only for the procedures we've performed over the last year or so....but we do NOT release our contracted rates for the reason you've noted.   Hospitals have reasonably good reasons for wanting to pass along our read fees to their/our patients but whenever I release them, I caution my contacts that this is Proprietary and Confidential and not for release outside the hospital system.    That wording is also included on the accompanied PDF.

     

    Along with that, I'm quick to make sure they understand that the vast majority of our services are contracted and if it's those rates they need, contact us directly and we'll vet the insurance on a case by case basis, then release the expected allowable with the obligatory this is only an estimate disclaimer.  I can't think of a lot of good reasons hospitals would want our contracted rates other than various legislation on fee disclosure, but that's intended for their rates only.   Heck it's challenging enough to stay on top of contracted rates by plan variances/plan types, let alone having to provide updated rates to parties outside our company.

     

    Sounds like we're doing what you're doing; not disclosing the contracted rate fee schedule based upon proprietary and contractual conditions and providing that info internally on a case by case basis.   

     

    Dennis J Chaltraw, CRCE │ Director Revenue Cycle Management │ Oregon Imaging Centers (OIC) / Radiology Associates, PC (RAPC) │ 1200 Hilyard Street, Suite 330, Eugene, OR  97401│ (w) 541.302.7771│ (c) 541.999.1848 | fax 458-215-4079│www.oregonimaging.com

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