Providers & Billing Companies Beware: Insurance Carrier Letters Advising Fee Schedule Changes

It has come to our attention that several commercial insurance carriers have been sending providers a letter that notifies them of an upcoming change to their fee schedule. We encourage healthcare providers and billing companies to carefully review the mail that they receive and pay attention to any correspondence from insurance carriers that discusses a change in fee schedules. The letters may be accompanied by a sample of the new fee schedule (a few pages), though they do not include the complete fee schedule (which should be upwards of 30 pages). These letters may contain language discussing a notice that in 90 days a new fee schedule will be implemented, and that the provider has 30 days within receipt of letter to contact the carrier with objections. In the cases that our office has seen, the fee schedule change will be implemented without need for further authorization from the provider. Unfortunately, this is a very discreet way for the insurance carrier to change the provider’s fee schedule (with potentially drastic reimbursement reductions) without requiring the explicit consent of the provider.

Please contact Healthcare Data Management for specific examples of letters that we have encountered and to discuss how we can help your practice protect its fee schedules.