Title
Fee Schedule Review for Lake County Health Department (all fees for clinical services) for Implementation in FY 2017 - Riley
Body
The Lake County Health Department and Community Health Center (LCHD/CHC) contracted with a consultant to review the current fee schedule for all clinical services performed. The medical services performed at the T.B. Clinic were included, as well. To meet this request, a fee schedule review was conducted.
As background for this analysis, it is important to understand the role of the chargemaster and a fee schedule within any organization. The chargemaster is a tool used across the organization to charge for services provided to a patient. 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) 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 actually reimbursed by a payor (i.e., Medicaid, Medicare, or commercial insurance). Also, fees do not necessarily represent what is actually collected from a patient or third party.
The chargemaster is an essential tool in the following processes:
* Revenue capture
* Enables the tracking of services provided
* Determining self-pay patients' eligibility for a sliding fee scale
* 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 li...
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