Fee Schedule Management 101 The health insurance industry is moving steadily toward consumer-driven plans, a concept which gives consumers greater control over their medical spending decisions. We’re seeing the advent of higher deductible insurance products, Health Savings Accounts, and some states (including Kentucky) reducing mandatory items that must be covered under an insurance contract. How will you respond to your patients with these types of coverage when they want to know how much your services cost and if they can set up a payment plan? Relevant Fee Schedule Now is a good time for you to look at your fees and payment policies to consider their relevancy in this new marketplace. Patients will increasingly become the purchaser for certain services rendered by physicians and in time become more sensitive to fees. You might want to look at your current reimbursements. Compare them to a fair markup over Medicare payments and from that determine a realistic fee for those services. More Price Shopping Otherwise, your unrevised fees will be presented to patients who, in talking with others or comparison shopping, may end up taking their business elsewhere. Macroeconomics always prevails. The marketplace will eventually adjust to the pricing a purchaser is willing to pay for a service. For the last 15 years with managed care, the market place has been composed of the insurance carrier (purchaser) and the physician (provider) who have determined the value for services. The patient only paid a limited $10 or $20 copay. Insurance carriers have allowed a physician to send them a bill for $100, but if the contract the physician has signed with the carrier pays $60, adjustments are made after the service has been rendered to the patient. However, in the new “high deductible” marketplace, the patient will increasingly be the purchaser of the service. To be sure they make the decision to proceed with the service, the quoted fee will need to be much closer to contractual reality. Should it be $65, $80, or another amount is something the marketplace will ultimately decide. Reevaluate Your Pricing For now, you should take some time to reevaluate your pricing. Determine if you’re comfortable with the $100 as your fee or somewhere in between $100 and the $60 you’ve contractually agreed to be quoted with the insurance companies.