If fees differ between insurance companies how can they be checked and monitored?
For example, a fee for a fictitious CCSD code XY4321 can differ between the big five insurance companies by as much as £100. Add to the equation another code. AB9876. It may or may not be performed at the same time as the XY4321 dependent of the insurance company concerned. Then the problem may become complicated.
AB9876 has 5 different fees anyway PLUS some insurance companies allow 50% of the AB9876 fee when invoicing alongside XY4321. Others, however, only allow 25% and the remainder don’t let AB9876 be invoiced alongside XY4321 at all!
Take a moment to realise why this is very important. It’s because if there is an error in the calculation, the chances are the consultant will UNDERCHARGE.
So how do you track and monitor the situation?
The solution is to create a grid that details all the codes you perform – most consultants do a relatively few different types of a surgical episode – and program the grid to calculate the correct fee for each code and the correct fee for each individual insurance company combination.
This is exactly what MHM does for all its clients by way of the “MHM Grid” and thus very, very rarely does MHM over (or more importantly) undercharge for anything.
Even more interesting is MHM don’t actually charge for building and maintaining a “Grid”. Clients get it free.
Do not, however, think, once programmed the Grid will always be correct.
The other factor is that fees and their combinations will and do alter over time. For example, if you check fees with BUPA you’ll discover the fees are correct up to October 24th at which point they may (but not necessarily will) change!
pete@medicalhealthcaremanagement.co.uk
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