When billing Medicare (or any other health plan) do you enter your fee OR Medicare's fee in the charge line? Also, is there any general guideline for establishing your own fee schedule? I know nobody can tell you what to charge but is there any general concensus (any percentage above Medicare rates) that seems to be usual and customary?
Joined: May 11, 2004
When sending a claim, you enter your fee on the charge line. I believe I read somewhere 120% greater than Medicare fee schedule. I wouldn't believe that though... you need to know your contracts and how your payments are determined, along with the way you practice. You should set your fee schedule based on how to capture the most dollars.
I would encourage you to look at your payor types and make sure that you establish your fee schedule significantly higher than your highest reimbursor. Make sure that you enter your fee schedule on the charge line, not what the fee schedule of the insurance company is.