AMA offers advice on obtaining, using contracted fee schedules

The American Medical Association has published guidance for physicians looking to identify their contracted rates with dominant payers and to verify they are being paid according to those rates.

“Obtaining, uploading and utilizing your fee schedules,” a new online tip sheet, is available free along with many other tools for contracting and billing, at the AMA’s online practice management center (link).

Practices typically have dozens of fee schedules in place with various payers, so the task of getting and organizing all of them and then using them to audit payments can be overwhelming. The AMA guide gives step-by-step instructions for the entire process (link).

The guide includes instructions for creating a spreadsheet of the practice’s most commonly billed CPT codes and how much the most frequently billed payers are supposed to be paying for those codes.

According to the AMA’s 2011 National Health Insurer Report Card, insurers pay 19.3% of physicians’ claims incorrectly (link).

Debra Phairas, a San Francisco-based practice management consultant, said she spends a lot of time helping physicians and their staff understand some of the same ideas. She helps physician practices create similar spreadsheets and upload the contracted payments into their billing software so they can verify incoming payments come in at the correct amount.

She advises practices to make sure they ask payers how many contracts are active under their names, to check for outdated contracts or any under old practices before they try to cross-check payments against contracts.

She also said sometimes billing staff is overwhelmed at the number of codes that have to be uploaded into software, but she recommends focusing on the ones that account for 80% of the practice’s business.

“Any well-run practice today really needs to do this — otherwise you’re operating in the dark,” she said.