Explain The Importance Of A Fee Schedule And The Factors It's Based On?

A fee schedule is a fee that is charged for services rendered. The schedule will usually list a maximum fee, for example a health plan which will plan out how the plan can be paid for, this would be in accordance of CPT billing codes, which is the factor on which it is based on. The CPT is the Current Procedural Terminology code, which is maintained by the American Medical Association, this is done through a CPT editorial panel. The codes are in place so a transparent system where medical services and procedures are communicated amongst organizations, patients, medical physicians.  If you are familiar with the coding for actual diseases, that is ICD-9 and ICD-10 coding then it is similar to this but it more identifies the service rather than the actual diagnosis.

So a fee schedule would cover the most common procedures carried out by physicians and surgeons. It should be set out as a guide and show the maximum and not just the standard fee for a given procedure, these fees should relate exclusively to the specialist’s time and expertise and should have no hospital costs reflected or be associated in any way. If the procedure looks to exceed the fee initially set out, then the specialist would be expected to discuss this with the patient. It is important to have these schedules supported by the AMA so costs are kept at a constant and have some congruency and patients and physicians receive a professional regulated service.

Look at the Understanding Medical Coding book. Page 426 under Fee schedules.

A fee schedule is based on three commodities the physician provides: Time, judgment and services. The individual medical practice determines the fees that will be charged for procedures preformed and tends to be based upon several factors:
  The economic level of the community
The physician’s experience
The medical specialty of the practice
Charges f other physicians in the area
The cost of the service or supply

Look in big Health Information Management Technology book. (p308)

The fee schedule is a list of health care services and procedures and charges associated with each. The fee schedule represents approved payment levels for a given insurance plan.

Fee schedule is a listing of the maximum fee which a health plan will pay for services based on CPT billing codes.It is important for the provider to determine the amount of fee to be charged to the patient.

Explain The Importance Of A Fee Schedule And The Factors It's Based On?