New Year – New Codes – New Allowables

2008.jpgWelcome to 2008! It’s already been a busy time. If you have not already done so, make sure you evaluate your fee schedules. There are new CPT codes and new reimbursements in place or will be put in place shortly.

While the intended Medicare 10% cut has not yet happened, the new rates are only good until June. Watch for impending changes…they may not be good for those of us who see lots of Medicare folks as 10% can be a huge cut in reimbursement.

At the same time, I noticed that Medicaid has cut its reimbursement and many of the commercial carriers are holding steady with last years rates.

Unlike business owners in other lines of work, health care providers, at least for now, seem to be at the mercy of the insurance carriers. While we can negotiate fees with carriers, it appears it will be a battle. I’m going to be working on one carrier shortly….I’ll let you know what happens. In the meantime to learn more, Medical Economics has published an article tis month: You Can Negotiate with Health Plans.

Comments 7

  1. I had a long delay getting contracted with ODS (an Oregon Insurance company), but thanks to the delay, I had learned a bit. (And thank you also Barbara for your recent article from Med Econ above). So when the contracting agent called me today, she said she was sending out the contract with a fee schedule of 59.00 per RVU. She said this was based on my surrounding area and the other payors. I nicely informed her that all of my other carriers with the exception of Medicaid and Medicare were paying me 63-65.00 per RVU. (Which was true) She increased it to 61.00 but said it was the best she could do. I asked her what the current RVU rate was for a few codes: and she told me a 99214 was 2.56, and a 99213 was 1.71. This was higher than what Providence and BCBS have calculated, or they are not using the newest 2007-2008 rates.. Based on what she quoted me, (and I do not have a calculator here, but as an estimate) I will get paid about 163.00 for a 99214 for ODS reimbursement. I was very pleased with this, as this was above what my current billing rate was for these codes. I would be interested to here how other NPs in Oregon are doing as well as NPs in other states.

    Being new to practice ownership, I did not even think of negotiating with my other contracts, they were just sent to me, and I was told what I would be paid. Now I realize it is up to us, to re negotiate when our contracts come due, and come prepared by bringing the correct numbers and data to the proverbial bargaining table. Carla

  2. Thank you Barbara for the link to the article. I have not been negotiating strongly enough and am more than happy to do it now to make sure I get paid more of what I am worth. I was using a billing manager and that keep me out of the loop, I plan to be more active from now on. I am even looking into taking a class to get better educated on how to get the most out billing for my time and patients visits.

  3. Have any of you heard or used the codes 99441, 99442,99443 for telephone services, or 99444 which is used for e mail. The guidelines are that the communication is about a c/c, in which the patient has not been seen in the last seven days, and they are not going to be seen in the next 24 hours.

    I have been getting a lot of email lately, through my website, mostly new patients, but a few cases would qualify for the above, and also some phone calls. Carla

  4. Post


    From what I am hearing, these codes are there, but very few insurers are paying for them. You will need to check with each insurance company.

    Caution regarding email….if you are going to recieve and respond to email from patients, your email needs to be secured and private (HIPPA). Regular email is not. You will also need to have in place some policies and procedures to protect you and the patient.

    In addition your website will need to have a disclaimer.

    At this time, I don’t have any email contact on my websites. I ask them to call or come into the office. This is both for their safety and mine. There is also a liability issue…I don’t want someone sending email telling me they are having chest pain and should I go to the hospital (true!). I may not get to my email for hours.

    I think as we move forward, more and more we will be using some sort of secure online system, but for now email is probably less secure than a fax (though not by much IMHO).

    I’ll try to write more about this later.


  5. Where may I get a good comparison price list for my services for superbill purposes?

    Cecelia Clarke NP-C/Owner
    Isle of Wight Family Practice

    New Practice opens 1 April 2008 Yaaaaaaaaaaaaaaaaay!

  6. You should go to Medicares site and look for the fee schedule. From what I hear, most usually look at the rates for Medicare for your area and make your fees using for ex 125% – 150% of Medicares fee schedule. This however does not work for medications.

  7. Barbara and Carla,
    I have to make a comment about receiving e-mails from patients. I have several patients who are deaf and they communicate to me when they need an appointment and I e-mail them back with time and date. I also have several who have no insurance and so cannot come into office regularly, but so that I will know if they are keeping their blood pressure or blood pressure for instance, within normal ranges, they will e-mail me their results for several days at a time and then I can either call them or e-mail them back on what I would like them to do with the results. Most of the time this is done through family and friends who have computers and are computer savvy because most of my patients have no computers or just do not have any experience with computers and so do not even try to use them. This helps me help them stay compliant or at least working on compliance. Otherwise, they would not even be aware of the normals and what they should or should not do about abnormals. This may not be HIPPA sanctioned, but I care more for my patients health than I do for rules that are put there to regulate everyone into regimented oblivion and the whole while the patient suffers. We’ll have to let the jury decide if erring on the side of the patient is more important than complying with the stuffed shirts of Washington DC who seem to come up with rules and regs all the time which just end up costing the tax payers more money and more time and paper work.


    Nina Ravey

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