AMA Wire

Wednesday, May 16, 2012

Practice News

12 steps can help you set a cost-based fee schedule

A set of AMA resources can help physicians establish their practice's fee schedule based on what it actually costs to provide specific services, rather than setting it based on what a third-party payer or other entity wants to pay.

An educational resource walks physicians through 12 steps to create their own unique practice fee schedule, while an easy-to-complete companion spreadsheet allows physicians to include additional markup percentages to account for profit, contributions to reserves and future capital expenditures. A chapter in the AMA's physician manual for evaluating new payment options also explains how physicians can determine their baseline costs.

By establishing a cost-based fee schedule, physicians can determine how the discounts of a contracted fee schedule with a health plan can impact their practice's bottom line and then make informed decisions about negotiating or signing a health plan contract.

Model rule tackles medical billing for workers' comp

A model state regulation endorsed by the AMA is designed to save millions of dollars by automating the process for medical claims in the workers' compensation system.

The regulation offers an opportunity to improve efficiency and lower costs by moving workers' compensation medical claims to an electronic process. According to an insurance industry study, processing a paper claim is nearly twice as costly as processing an electronic one.

"Bringing the billing process for workers' compensation insurance into the electronic age will benefit physicians, employers, insurers and state governments," AMA Board Chair-elect Steven J. Stack, MD, said in a news release.

Developed by the International Association of Industrial Accident Boards and Commissions (IAIABC), this model rule is expected to reduce administrative costs and paperwork. California and Texas already have adopted rules based on this model, and other states, including Georgia, Louisiana, North Carolina and Oregon, are moving in the same direction. The AMA is working with IAIABC and other medical associations to promote adoption of the model rule across the country.

Physicians can access the AMA's workers' compensation toolkit to learn more about taking advantage of the benefits of electronic billing and to find state-specific resources.