Fees Articles and Resources
Setting fee schedules is a process that can have a lot of questions, but it’s a crucial component of the claims reimbursement process. There are many different ways that fees are calculated and evaluated and location (e.g., inpatient, outpatient) makes a big difference. Find-A-Code shows many different types of fees when reviewing the code information page (e.g., Medicare, UCR).
For more information about fees, please refer to the “Guide” found on the “Guide” tab above.
Click on the following links for additional fee information:
Resources
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Additional Links and Resources
There are 13 sections in the Guide.
Select the title to see a summary and a link to the full article. some articles require a subscription to view.
Oct 30th, 2024
What are the Different Medicaid Payment Systems?
The Medicaid payment system, which funds healthcare for low-income individuals and families, is complex and varies by state. It generally works through a combination of fee-for-service (FFS) and managed care models, with federal and state governments sharing costs. This article contains information to help explain some of the different ways that Medicaid pays for healthcare services.
The Medicaid Chronic Illness and Disability Payment System (CDPS) is a diagnostic-based risk adjustment model used to calculate payments for Medicaid health plans, particularly for those covering individuals with chronic illnesses and disabilities.
A conversion factor is a dollar amount that is applied to an adjusted Relative Value Unit (RVU) to arrive at a fee. Conversion factors can be based on a geographic location as well as a national level. The article contains information from the Veterans Administration about how they create their geographically-adjusted 80th percentile conversion factors.
Jul 31st, 2024
Where are UCR Fees Located in Find-A-Code?
by Wyn Staheli, Director of Content - innoviHealth
UCR fees can be found in several places within Find-A-Code. The most commonly used place is found in the Fees section of the individual code. When you are on the code information page for a specific code, scroll down to the fees section and click on the bar titled “Fees” (as shown below) to open this section:
Jul 25th, 2024
Does the Pro Fee Calculator Include UCR Fees?
by Wyn Staheli, Director of Content - innoviHealth
Find-A-Code’s Pro Fee Calculator is an easy-to-use tool for calculating fees for CPT and HCPCS codes. Need to apply modifiers or additional units? The Pro Fee calculator can do this and much more. Check it out.
Jul 25th, 2024
Where does Find-A-Code get UCR Data?
by Wyn Staheli, Director of Content - innoviHealth
Find-A-Code provides UCR fees gathered from the US Department of Veterans Administration (VA) using Geographically-adjusted charges and the 80th percentile conversion factors; this information can be found on the code information page (see example below) and is available for performing a fee comparison with our UCR Pricing add-on.
Jan 10th, 2024
Government Shutdown Looming as Congress Dithers
by Matthew Albright
Like most of the world, I procrastinate when paying my bills. I tend to put them off until the very last minute. And that pretty much explains Congress’s strategy last year – and they clearly plan on continuing this approach for 2024. The tough stuff, like funding a government,...
Nov 6th, 2023
CMS Issues Final Rules for PFS, OPPS/ASCs
by Mark Spivey
The regulatory changes will create a variety of changes for providers. Amid a flurry of regulatory activity, federal officials late last week issued twin final rules governing changes to the Medicare Physician Fee Schedule (PFS) and the Outpatient Prospective Payment System (OPPS), with the latter also featuring adjustments...
Jul 14th, 2023
CMS Unveils 2024 Medicare PFS, OPPS Proposed Rules
by Mark Spivey
The OPPS proposal did not feature reference to several high-profile issues industry leaders have been awaiting reform on. Federal officials yesterday unveiled a pair of proposed rules, featuring potential adjustments to the Medicare Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) for the 2024 calendar year....
by Kem Tolliver, CMPE, CPC, CMOM
Each year the Centers for Medicare and Medicaid Services (CMS) rolls out the proverbial carpet and ushers in new rules on regulatory compliance, coding and reimbursement. Now the dust has settled, learn about the greatest impacts as a result of the CMS 2023 Final Rule. Gain insight into the top 5 regulatory and reimbursement changes that will impact the healthcare industry
Jan 26th, 2023
Relative Value Units (RVUs) the Easy Way, Really?
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The Medicare Physician fee schedule was implemented in 1992 using a relative Value scale methodology called RVUs to base payment rates on the resources used to perform the service. This is currently how the Medicare Physician Fee Schedule (MPFS) is set. But beware, there may be an industry-wide change to a Value-Based Payment. We will save that for another time; this article will focus on how the RVUs are calculated and Medicare Fee schedules.
by CMS - MLNConnects
Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
by Amanda Ballif
Beginning July 1, 2022, CMS started to enforce applicable price transparency requirements because of the Trump Administration's historic price transparency requirement in 2019 to increase competition and lower healthcare costs for all Americans.
by Amanda Ballif
The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.
Feb 15th, 2022
Interpreting the VA's UCR Pricing
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Representing the methodologies used in the VA's pricing determinations is better understood coming directly from the source or an attorney who is familiar with the laws. Our responsibility is to educate you with information directly from the source, where you can find your answers or contact them directly. We are happy to ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
As per customer request, Find-A-Code now offers UCR Anesthesia Fee Calculations along with CMS and ASA. The anesthesia fee calculations can be found under the Fees section of the code and under the Anesthesia Fee Information.
Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units).
NOTE: Always ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...
Sep 23rd, 2020
My Location and CBSA is Missing!
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
We often get questions on missing Core Based Statistical Areas, known as CBSAs. CBSAs are used for pricing and other factors according to the geographical location. If you do not see your CBSA, it is important to note they are not missing - it may not have an assignment, according to ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...
There are 9 related documentation, coding and billing tips.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Jun 2nd, 2022
Coding 2022 Care Management Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Anyone who sees patients who have services that are not covered by insurance needs to know about the No Surprises Act. In this quick webinar, Dr. Gwilliam will show you how to properly notify patients of their options and create a Good Faith Estimate, as required by this law. Expect this…Feb 15th, 2022
Pro Fee overview with UCR Fees.
by Alan Crop, VP Sales - innoviHealth
Dec 21st, 2017
What is RBRVS and How Can It Benefit Your Organization
by Find-A-Code™
What is RBRVS and How Can It Benefit Your Organizationby Find-A-Code™
The Importance of Gathering Organizing and Using Fee SchedulesLinks and resources by topic.
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Fees
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