Why it’s Important to Report Your Standard or Regular Fee on Insurance Claims

It is wise to review your standard fee schedule yearly to verify costs to produce the services that you provide.   If in doubt to whether your fees are within the realm of reasonable and customary for the area you can have an outside fee analysis done.  Your fees should be above the UCR or allowable fee reported by the insurance company.   Contact your software supplier for reference as they may be able to supply one at a substantial discount on a fee analysis.

•         If you report the full fee on all claims going out whether in or out of network you will be able to compare multiple PPO plans to determine which plans require the largest adjustments or write-offs.
•         When PPOs decide to increase their allowable pay tables they take an analysis of fees submitted on claims to determine if and how much will be raised.  If the claims have been submitted with outdated or lower fees you will not be awarded an increase in reimbursement.
•         Payers track the amounts reported on claims to establish realistic allowable fees.  Billing the lowest contracted fee because you don’t want to do ledger adjustments will affect whether fees will be raised by the insurance company in the future.

When you bill the full fee or your regular standard fee on all claims, it is easier for you to track which plans have the largest write-offs.   You will also be paid at an indemnity rate on some plans that pay the UCR instead of lower contracted fees.