Title
Fee Schedule Review for Lake County Health Department (all fees for clinical services) for Implementation in FY26 - Cooper
Body
Lake County Health Department Community Health Center (LCHDCHC) reviewed the current fee schedule for all clinical services performed. The medical services performed at the T.B. Clinic were included as well.
The chargemaster is a tool used across the organization to charge for services provided to a client. Fees in the chargemaster are established for each type of service provided, such as a visit, procedure, or medication. Each service is defined by a unique code that describes the specific service being provided. Either a CPT (Current Procedural Terminology), CDT (Current Dental Terminology) or HCPCS (Healthcare Common Procedure Coding System) code is used.
An important principle is that the same fee is charged for the same service throughout the organization. Note that fees or charges are not the same as the amount that is reimbursed by a payor (i.e., Medicaid, Medicare, or commercial insurance). Also, fees do not necessarily represent what is collected from a client or third party.
The chargemaster is an essential tool in the following processes:
* Revenue capture
* Enables the tracking of services provided
* Comparing organizational fees to the market
* Negotiating appropriate payment rates for managed care and other third-party contracts
The strategy underlying the proposed revised fee schedule is based on the following assumptions:
* Access to services for individuals with limited financial means is part of the Health Department's mission and needs to be maintained.
* The financial resources of the Health Department are limited.
* Changes to fees affect self-pay clients, contract rates for commercial and fee-based Medicaid and Medicare contracts. In addition, fee changes will affect reimbursement levels that Medicare clients seen in the FQHC are reimbursed.
* The methodology for fee development is con...
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