Q1: It's Time to Update Fee Schedules and Optimize Payment!

Welcome to Quarter 1 of the OP Educational Experience!

Every year, payers update their fee schedules. When was the last time you reviewed your practice's? It's important that you do so on a regular basis because if your fee schedule is outdated, you are most likely leaving money on the table. In Quarter 1, our focus is on updating your Fee Schedules. 

Return to the Educational Experience Homepage

Expand the sections below to get started!

Webinar Recording: "Updating Your Practice Fee Schedule" 

In this webinar, presented by Sue Kressly, MD, FAAP, you will learn:

  • The importance of reviewing and updating your fee schedules on a regular basis
  • Methods to create a fee schedule that is consistent and supports practice financial metrics
  • The impact of monitoring payments throughout the year to maximize revenue

Resource Links

Identify Underpaid CPT Codes

Learn how to run an SQL/script to identify any CPT codes that you have been potentially underpaid for because you are getting paid 100% of your charges.

Full video run-time: 26:47

Leverage CMS RVUs

Learn how to download the CMS RVU spreadsheets off their website and use them as the basis for this work.

Part 1: RVUs and the Medicare Fee Schedule

Full video run-time: 12:11

Part 2: Creating a Medicare Physician Fee Schedule

Full video run-time: 9:25

Resource Link

Part 3: Other Medicare Fee Schedules

Full video run-time: 6:05

Resource Links

Pay Attention to Vaccine Charges and Optimizing Your Payments

Learn how to manage your vaccine CPT codes and fee schedule(s) in OP so that you can maximize your vaccine payments.

Update Your Vaccine Fee Schedule

Full video run-time: 10:51

  • How can you see vaccine fees at a glance? 0:07-7:38
  • How do I make an alternate (VFC) fee schedule? 7:39-9:20
  • How do I associate this alternate fee schedule to my Medicaid plans? 9:21-10:51

Resource Link

Part 1: Monitor Vaccine Charges and Payments

Full video run-time: 5:48

  • How do you compare prices to what you paid? 0:07-3:49
  • Overview of SQL Results 3:50-5:48

Part 2: Monitor Vaccine Charges and Payments - Analysis and Conclusion

Full video run-time: 13:37 

Resource Links

OP Help Resources 

Fee Schedules
Modify and Copy Fee Schedules
SQL: Entire CPT Code Table Record, Including Fee Schedules
Video: Fee Schedule Maintenance

Advanced Workflow Rules Engine 
formerly Block and Substitute 
Advanced Workflow Rules Engine (OP AWARE)

Add, Edit, and Copy Insurance Contracts
Associate an Insurance Contract with a Payer
Update Insurance Contracts
Using the Update Insurance Contracts Window
SQL: Contracts Module Review
SQL: Expected Revenue - Charges and Contracted Rates
SQL: Decreased Payment for Sick with Well

*** All of the topics above play a part in a payer's setup in OP ***