General Financial Performance

General Practice Management

A NEW METHOD FOR EVALUATING YOUR FEE SCHEDULE AND CALCULATING YOUR COLLECTION TARGET

The August/September 1999 issue of Watching Your Bottom Line discussed evaluation of your practice’s fee schedule based on the use of the Resource-Based Relative Value Scale (RBRVS). In that issue, the RBRVS was used to identify overpriced and underpriced services, as well as to calculate the relationship between the practice’s fee schedule and the allowable payment schedules of the practice’s payors.

Many managed care payors are moving to an allowable payment schedule based on the Medicare Fee Schedule (MFS). For those of you who have a managed care plan that is paying a percentage of the Medicare Fee Schedule, this issue’s sample calculations will simplify analyzing your fees, recalculating your fee schedule, and calculating a collection target.

MFS Calculations

Fee Analysis
The following table shows how each fee (average charge) compares to the medicare allowable as well as how the total charges at the practice’s fee compare to the same services based on the MFS. (The fees and MFS allowables shown in the table are for demonstration purposes only.)

A

B

C

D

E

F

G

CPT

Total Count

Total Charges

Average Charge (Fee)

MFS

Total @ MFS

Medicare as % of Fee

11400

7

$1,029

$147

$86.10

$603

58.57%

11900

5

$378

$76

$36.05

$180

47.69%

65222

18

$1,620

$90

$144.55

$2,602

160.61%

65730

10

$32,000

$3,200

$1,045.45

$10,455

32.67%

65755

8

$23,280

$2,910

$1,092.35

$8,739

37.54%

65772

8

$13,200

$1,650

$357.00

$2,856

21.64%

65805

7

$2,118

$303

$141.75

$992

46.85%

65855

35

$50,050

$1,430

$350.70

$12,275

24.52%

66170

9

$13,200

$1,467

$866.60

$7,799

59.09%

66250

4

$2,936

$734

$478.80

$1,915

65.23%

66625

6

$5,820

$970

$431.55

$2,589

44.49%

66761

13

$12,600

$969

$311.85

$4,054

32.18%

66821

219

$273,000

$1,247

$186.20

$40,778

14.94%

66984

547

$1,023,290

$1,871

$714.70

$390,941

38.20%

67038

22

$92,180

$4,190

$1,479.45

$32,548

35.31%

67039

6

$6,334

$1,056

$1,034.95

$6,210

98.04%

67040

5

$11,751

$2,350

$1,214.85

$6,074

51.69%

67105

21

$14,685

$699

$573.30

$12,039

81.98%

67107

7

$18,018

$2,574

$1,074.15

$7,519

41.73%

67108

9

$19,560

$2,173

$1,493.80

$13,444

68.73%

67141

11

$9,846

$895

$426.65

$4,693

47.67%

67145

93

$73,480

$790

$408.80

$38,018

51.74%

67210

166

$217,960

$1,313

$619.50

$102,837

47.18%

67220

28

$28,188

$1,007

$710.85

$19,904

70.61%

67228

64

$88,100

$1,377

$815.50

$52,192

59.24%

67345

6

$1,259

$210

$218.40

$1,310

104.06%

67800

16

$2,720

$170

$171.85

$2,750

101.09%

67810

5

$1,500

$300

$150.85

$754

50.28%

67820

9

$495

$55

$66.85

$602

121.55%

68760

10

$1,628

$163

$186.55

$1,866

114.59%

68761

43

$5,110

$119

$168.00

$7,224

141.37%

76512

138

$23,158

$168

$92.40

$12,751

55.06%

76516

7

$1,351

$193

$75.60

$529

39.17%

76519

504

$63,809

$127

$75.60

$38,102

59.71%

92002

277

$17,954

$65

$60.20

$16,675

92.88%

92004

908

$78,498

$86

$100.80

$91,526

116.60%

92012

2479

$134,997

$54

$51.10

$126,677

93.84%

92014

427

$24,619

$58

$73.85

$31,534

128.09%

92020

73

$4,015

$55

$31.50

$2,300

57.27%

92083

651

$48,633

$75

$56.00

$36,456

74.96%

92135

430

$42,600

$99

$67.55

$29,047

68.18%

92225

935

$53,278

$57

$53.90

$50,397

94.59%

92226

1196

$65,670

$55

$53.20

$63,627

96.89%

92235

282

$60,777

$216

$99.05

$27,932

45.96%

92286

442

$92,200

$209

$86.80

$38,366

41.61%

99202

82

$4,669

$57

$60.55

$4,965

106.34%

99203

5

$438

$88

$85.05

$425

97.09%

99204

15

$2,340

$156

$122.85

$1,843

78.75%

99211

30

$792

$26

$19.25

$578

72.96%

99212

1741

$75,845

$44

$32.90

$57,279

75.52%

99213

1825

$88,498

$48

$45.15

$82,399

93.11%

99214

25

$2,040

$82

$69.65

$1,741

85.36%

99242