Master 2025 Medicare Fee and Billing Compliance: What’s New and How to Get Reimbursed More?

Event Materials (Key Required)

This webinar by Don Self, CEO, CPC, CEMCS, CPCS covers the rules and regulations regarding clinic and provider medical fees and how to determine what to charge. There are myriads of different approaches to determining the proper fees to charge and this webinar covers about nine of the most common ways fees are selected. We will also discuss different regulations regarding Medicare fees versus commercial insurance fees as well as dealing with patients who prefer to pay cash.

Expert Don will also show how important making sure your fees as he will show where hundreds of physicians throughout the country are charging fees so low that they are reducing their insurance payments.

Learning Objectives:

• Review 2025 Medicare Physician Fee Schedule (MPFS) Rules
• How your fees may result in reduced insurance payments
• Why using Medicare fees as a guide may not be a good idea
• When you are allowed to charge patients less than insurance companies
• How to apply hardship discounts when necessary
• How charging what you believe the allowed is may be hazardous
• When patients can elect to not have insurance filed and affected fees
• Why cash discounts can be considered discriminatory
• What fee should be charged if patient signs an ABN
• How often you should review and adjust your fees

Areas Covered in the Session:

• How Do You Determine Your Fees?
  • Toss the Dice and See What to Charge?
  • Compare the Fees of Another Practice in Your Area
  • Use Medicare Fees Exactly
  • Buy A Program
  • Calculate the RVUs x GPCI x CF x 2
  • Workers Compensation Fee Conversion Rate
  • X Medicare RVUs – X1.5 Or 2
  • Buy the Data from Fairhealth
  • Get Limited Data from Fairhealth Consumer Site
• Do You Use Medicare Fees?
• Medicare Favored Nations – Sect. 1128(B)(6)(A)
• Why Do Fees Matter?
• Docs Who Charge Less Than Medicare Fee Schedule
• What Determines the Allowed Amount?
• Medicare: The Lower of The Billed Amount or The Medicare Physician Fee Schedule
• What About Commercial Fees?
• Commercial Provider Agreements Always Have Something Similar To: The Lower of The Billed Amount or The Usual Allowed
• What About Fees?
• Should I Bill the Amount the Carrier Tells Me Is the Approved or Allowed Amount to Reduce Adjustments?
• MPFS Can Be Adjusted Several Times A Year
• Fees For Deposition/Testimony
• What Is Your Provider’s Time Worth?
• Can I Charge Different Fees to Different Payers?
  • Texas – Texas Insurance Code § 552.003
  • Prompt Pay – Discount If Fee Paid on Date of Service
  • Hardship – Hardship Discount Rules 200% Of Poverty Guidelines
• What About Cash Pay
• 2024 Federal Poverty Guidelines
• Patient Revokes Permission for You to File Insurance
  • Bill Any Amount You Wish
  • PPACA & HIPAA Allows This with All Insurance
• Medicare ABN

Suggested Attendees:

• Healthcare CEOs
• Healthcare CFOs
• Healthcare COOs
• Billing Personnel
• Clinic CXOs
• RCM Executives
• Hospital Administrators
• Claims Staff
• Appeal Specialists
• Office Managers
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Practice Manager
• In and Out of Network Providers
• Providers Office Staff
• Hospitals and Facilities
• Insurance Companies
• Healthcare Attorneys

Presenter Biography:

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Additional Information:

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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Purchase Order Form – Click Here to download PO form.

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Snippet From Our Previous Session