Blog, Chirosecure Live Event February 7, 2023

2023 Fee and RVU Updates – Sam Collins



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Welcome in, my friends. Glad to be with you again. Let’s begin this new year. We’re a bit into the new year, but let’s begin this new year by making sure we’re up to date doing the things properly, and we’re gonna focus on today’s program on dealing with what should be my fees, should they update what happened to relative values?

And I’ll say, really, are you really maximizing your payments? One of the issues I get up commonly for my network members is, What are my fees? What should I charge? What’s fair? What’s reasonable? That’s one of the things we really wanna focus on because obviously that is the bread and butter of your practice is the reimbursement of your services, whether it’s gonna be cash, insurance, or otherwise.

So let’s focus in, let’s get to the slides. Let’s talk about what’s going on for this year, for 2023, and what’s going on for fees, relative values, and frankly, are you just maximizing your payments? We did a whole seminar program on that this year, just to make sure your offices are up to. Let’s talk about what are fees.

The bottom line is what are your patients number one want to know, or what are they looking for is how much is it gonna cost? What is your fee? The chiropractor has to look at it from this standpoint. How much should I charge? What is reasonable, what is fair, what, how much value do I have to my service?

Realize, Is a person really choosing you because you’re cheap? I think it’s one of the things, particularly new doctors often are afraid of charging what the services really may be worth. Think of it this way. Have any of you ever chosen a doctor because it was cheap. . Obviously you look at fair pricing and something that’s reasonable, but it’s cheap how we choose a healthcare provider.

So I would be careful of thinking cheap is good. In fact, sometimes cheap is associated with not much quality. Let’s face it, the 99 cent store has a lot of cheap things, but do we expect much quality? So I want you to think of how do we make an update here? Should we change it yearly? Does it even change yearly?

Should it change? Must it change? Now, one of the problems we run into is of course, manage. You belong to something like an As, h or otherwise, and those pretty much don’t update however, , can you request an update? So if you’re a network member with me, one of the things I would suggest is one of our meetings should be on how to deal with, how do you request an update.

Believe me, you can get an update or an increase in fees. You just have to know how and when and what to ask. But let’s talk about other fees like Medicare has Medicare increased fees this year. Yes and no. For the most part it’s flat. Initially they were gonna go down and then of course Congress met and they put it back up again.

But nonetheless, I’d say it’s mostly flat. Most areas are probably within 10, 10 to 20 cents per code, give or take. So not a big difference, but nonetheless, I’ll say a net increase maybe. And that brings me to what is usual customer unreasonable. You’ll hear this term a lot. I wanna make sure there’s a clear understanding.

It is the mouth that is typical in your geographic area, what people charge and get paid. In some areas, and I’ll give an example, in some areas of San Diego County, which is one of the more expensive areas to live, it’s a very beautiful area of Southern California. There’s a few areas where their usual customary reasonable is really low because they have a number of these low cost chiropractors, like the joint and several others.

So it’s brought down the cost of the neighborhood because what’s usual there is these stores. If you were around a bunch of 99 cents stores, what would be the usual price? So of the same idea. So you want to think of what is usual custom. Reasonable. In other words, what do I charge? What will people be willing to pay?

So it’s the fee you charge based on the area and falls within a price range that others charge. Let’s keep in mind. Because another doctor charges a price. Does that mean you have to charge it? Could your services have more value? They could if someone’s willing to purchase it. So it comes down to that.

Obviously we’re dealing with a bit of insurance as well. So what is insurance allowing, and this is where I’m concerned, is many times providers are only billing maybe seven or eight codes on a regular basis. And while one or two of them may have the right values, Many of them don’t. I often find, particularly for new network members that join with us when they join and we do their fee schedule review, I’ll find that they’re billing a codes and usually half of them have improper fees, which means literally 50% of their revenue is being run out the door cause they just did not understand the value of the service.

So what I’d like to use to help with this, and I’m gonna give you an opportunity to do that today, are the relative value units are often termed to RVs and relative values are nothing more than the relative price of one service. to another service. If you tell me the price of a 9 80, 9 40 or any code, I can then tell you what the price would be for another service based on the relative value of that service.

To the other code or to manipulation by example. So this was data that was developed all the way back to the eighties. It’s something that’s updated yearly. CMS uses it and pretty much most insurance plans to an extent do. Obviously some of the managed care ones prefer not to and just charge less and see, we’re willing to accept, but for the most part, it’s gonna be used by all plans, including Medicare, work comp and others.

So what I wanna do is take a look at that and see how do we use this to help? So what I’d like you to do right now, at least think of it, or if you wanna write it down, and I’m gonna give you an opportunity, we’re gonna give you a calculator to do this so you don’t have to do it all on your own.

But let’s think for a moment, what is your fee for 98, 9 40? What is it right now? Whatever that is fine. But then I wanna know what is your fee also for a 98 9 41? Mid-level new patient exam 99 2 0 3, and then your fee first say massage, but it could be any service. It doesn’t have to be massage, but I just picked these four cause I’d say they’re relatively common.

Let’s break it down. So let’s say we look at the value of each service. So you’re gonna see a term to RV or the relative value. Now you look at this and go what is point A two, Sam? That’s actually a little bit of an increase. Last year it was 0.81. The RVU now for 99 4 is 0.82. For 98, 9 4 1. It’s 1.1 8 9 9 2 0 3.

3.33 and nine seven. 1 2 4, 0 0.9. Now you might look at that and go, I don’t get it. , I’ll put it in this way. Let’s make it simple. Let’s just say we make that dollars. So if your fee for a 9, 8, 9 4 were $82, what would be the fee for a 9 89 40? 118 or for an exam 333. Now that may be a little high, but you get my point.

It’s the relative price of one to the other. So in simplest way, I think you could look at this and go my fee for a 9 8 9 4 1 should be basically 36% higher than the fee for a 9 8 9 4, or my fee for a 9 9 2 0 3 should be roughly four times the. of your 9, 8, 9, 4, and then massage if you would’ve maybe about 8% higher.

So let’s take a look at how this actually does work. So I’m gonna show you an example here. What if you were charging $60? For 99 4. And that’s the fee people pay you. You’re going, yeah I bill 60. They pay me 60. Particularly personal injuries and others, ones that aren’t stuck with some sort of managed care fee, you’ll say, yeah, 60 is what they, what I charge is what they pay, so let’s make sure we have the right price for the other services.

If I’m charging 60. For 9 8, 9 40, I’m gonna take 60 divide by point A two. I have a mistake here. It says eight. When it’s actually a two. It’s gonna give me a conversion of 73 17. I now then take 73 17. multiplied by 1.18, and it gives me 86, 34. So notice the price difference here is about $26. And if you look at that, you’re gonna go, oh yeah, Sam, that is about 33% or 36% higher.

And I want you to start to use that because often what I find is an office will say, oh, I charge 60 for a 99 40, and then consequently charge 74 41. And I’ll go you can charge 70, but why? Why did I choose 70? And not 86. And mostly it’s because I didn’t know. The value is not simply just $10 higher.

It’s nowhere near that. Again, it’s about 36%. Let’s do the same for a 9 9 2 0 3 notice 73 17 times 3.3 3 2 43. So my point to this is if I’m charging 64 4 oh. That means my 41 price would be 86, my four, my 99 2 0 3 price would be 2 43 because I can tell you that’s the relative price based on a $60 value.

Know, you might say Sam, where you come up with 60, this is your fee. I’m not trying to tell you how much to charge, but once you tell me what you’re charging, even for one thing, I will tell you what the relative price should be for something else. It’s kinda like a neighborhood. If you own a. in a neighborhood and it’s the same size, square foot and all that as a house two doors down and that house sold for $500,000.

What do you think your house is worth? Approximately that. Let’s do the massage. Notice here. Massage is slightly higher and this is one that’s frustrating to me cuz I often find doctors of chiropractic will charge their 98 9 4 oh at a higher value than 9 7 1 2 4, which again, that’s up to you to charge what you feel it’s worth, but I want you to know that massage, at least for a four.

has a higher value, but yet providers seem, for whatever reason, charge less. So why would I charge by example? I’ve seen this happen. They’ll charge 64 an adjustment, and then 45 for the massage. And I thought why are you charging $45 for a code that’s worth 8% more? . And again, if they’re willing to pay 60, that will be the higher rate.

So I’m gonna show you some examples of it. And I just chose Illinois just because it’s center of the country. I could have picked something east or west, but I just thought pick center. But I’m gonna break down here how they pick these codes and fees. Cuz here’s the Medicare fee schedule for this year.

So notice we’ll just pick the first county here, which is our, bomb county. But you’ll notice here it allows 27, 24, 40, 39, 14 for a 41. So let’s do the. 27 20 divided by 0.82 gives me 33 17. Now I take 33 17 and I multiply it by 1.18 and you’ll notice that gives me 39 14. Notice the value here. 27 20 39 14.

Do you see how it works? Simple as that. Medicare certainly uses it, which means pretty much most carriers accept managed care will. And I also put the fees here for 9 9 2 0 3 and 1 2 4 for Medicare in this area. And you’ll notice immediately wow, one 20 is basically four times that. And then of course we notice 31 53 again is slightly higher than the 27 20.

In fact, if you do the 8%, you’ll see it. So I’d like you to start thinking along the lines of, have I set a fee schedule that makes any sense at. From the value of one thing to another. Now again, always your choice to say . I don’t want to charge 86 for my 9 89 41. I prefer to charge 70 because my patients can’t afford it.

Okay, I’ll accept that because you have a valid reasoning. My reasoning coming back to you though. Good. But be why? What made you determine that? Particularly if you’re billing insurance? Of course. by example though. How important are VUS is to take a look at many states, use them to determine all types of fees.

Texas, the conversion for this year is 64 83, so you take the rvu type 64 83, or Utah, the same thing. But look at Michigan, third one down 200% of Medicare. So personal injury in Michigan, you could charge as much as 200% of Medicare. , that’s double. But think of it, let’s go back to this for a moment.

Let’s assume most of us charge probably $50 to maybe 64, 9, 8, 9, 4. Oh. So let’s double this 27, let’s make that 54 rounded up to 55 just for easy serve purposes. Notice if we double the 9, 8, 9 41, that’s gonna be 40. So if it’s 50, , or excuse me, it’d be 80. You’ll see here that conversion fits. And so I think many of you have fees that you’ve never looked at the relative values to figure out the differences.

Here’s some more examples. The Blue Cross Blue Shield, if you have a Boeing employee pays 175% of Medicare rates. That’s the max they’ll allow. Pennsylvania Work Cup has its conversions. Each state a little bit different. What I want you to start to do is really start to look at your fees and codes.

Now, I can help you with that. If you’re a network member, you contact me. That’s one of the big meetings I do with you as network members. But let’s go ahead and do this. We’re gonna give you a simple calculator to help you. with a few codes. So all you have to do is take your phone out, go up to the screen, that QR code will send a text directly to that number.

Or if you can’t get it to work, don’t panic and oh wait. As you take it down, relax, just text the word RVU to 7 1 4 2 8 0 4 6 9 7, and when you do, you’ll get a bounceback. What it’ll allow you to do is go ahead and put in your 9 89 4 oh price, and then once you’ve done that, it’s gonna come back. What the relative values will be for the four codes I.

So it’s a way to start looking, going, oh, now I see how this matches. Now again, what do I do with this tool? That doesn’t mean you have to charge that much, but it gives you what the relative price would be, and then you can make a decision to say, oh, you know what? I charge a little less, or maybe you wanna argue, you charge more, but if you charge more, why is the other fee lower?

I want it to all make sense. So I’m an employee to start to really use some real logic behind your fees so that when someone disputes your fees, you’re gonna have a valid reason. How did you determine your fees? I use the relative value units based on. The pricing or value of the service that you’ve paid here for one service to base everything else.

I use Medicare protocols as well. What we wanna focus in on is making sure it’s fair and reasonable and mostly fair and reasonable to us. One of the things I do when someone joins our network, one of the first big meetings we have is to go over your fees. When I go over them, I can invariably tell you almost.

has 50% of their fee schedule. That makes no sense. Cause I’ve just given these four codes. Now grant you, you’re not doing like 20 more codes, but I bet you’re doing about eight to 10, maybe even 15. Think of how much money you’re losing by not understanding the changes and how they update year to year.

So take a moment to do that calculator. Probably get a hold of me. We do a network service where I do this with you one-on-one for a yearly fee for less than a thousand dollars. You get me as a staff member. Call me, email me. We do Zoom meetings. It also gives you two free seminar. I am with the HJ Ross Company.

I’m the coding and billing expert, and along with ChiroSecure, your success is ours. If you’re not successful, I’m out of work, so let’s make sure to be successful. Everyone, I’ll catch you next month. Thanks.