Q&A: Setting fees

September 5, 2008

How do I set fees that are high enough to maximize what Medicare and commercial insurers will pay me without overtaxing cash-paying patients?

Q: How do I set fees that are high enough to maximize what Medicare and commercial insurers will pay me without overtaxing cash-paying patients?

A: Review the reimbursement rates of your largest four or five commercial payers and use the highest payer's rates as your starting point. Setting your own fees at least 10 percent higher will protect you on the insurance side. To ease the bite on your fee-for-service patients, you could offer an equivalent discount for paying in full at the time of service.