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Rates

Leah T. 2 years ago in Billing/Electronic Modules updated by Richard Sethre, Psy.D., L.P. 2 years ago 9

Outpatient mental health clinics- Do you have the same rate for services across all insurances and if so does it make your adjustments look high at the end of the month since a commercial insurance might pay more than MA? 

Yes, we do the same billed amount for all payers

Do you find that it appears that you have a large adjustment when looking at reports since some insurance companies pay way less than others and you charge the same for each payer?

Yes, we do see this and are actually having issues with negative net billings because of this issue. Also we feel that if payments get delayed for any reason we are overbooking our revenue for the month because we don't adjust off our contractuals until we get the remittance. Does anyone use the expected revenue column in the payers module to auto adjust off the contractual adjustments at the time of billing?

We do not, I didn't know that was an option

My understanding is that you have to charge the same amount regardless of the payer.  You can't treat patients differently based on their insurance.  We do charge the same.  We do use the expected revenue column, for payers we have a contract with and know what they will pay.  I know our accountant does an adjustment at the end of each month for expected adjustments so it doesn't throw off our revenue for the month.  I believe she calculated an average and uses this figure.

We charge the same across all payers - MA rate times 25%, to be safe. I have never had a commercial plan pay more than MA, and would be very interested to know which commercial plans do pay more?

All insurance companies should be charged your published rate.  Yes, the adjustments could be large sums.  As to which insurance companies pay more...It is not appropriate to discuss what insurance companies reimburse as every provider/entity negotiates contracts/rates.  The small print in the contracts clearly states that the rates negotiated are confidential.  Any provider that chooses to discuss what they are being reimbursed could in fact have their contract terminated with any of the payers.   

Susan's info is correct and is a concise summary of billing issues and the risks of not knowing the fine print of contracts. What many clinicians/clinics do is set a rate for each service that is higher than what you expect to collect from your best payer - at least a little higher. I know of many clinicians who have published rates that seem outrageously high - I'm sure they never get the full amount, unless they have a private pay person with deep pockets.  I am not aware of any problem with setting rates that are high in order to ensure that we don't short our self by billing less than our contracted rate - expect for possibly feeling embarrassed when regular people as our "published rate."

Not asking for specific rates - asking which commercial plans pay more than DHS. I am fine not knowing, just not aware that is a possibility. That is why we have always used the DHS rates as a baseline and done our increase from there.