Advantage: You may be on target and happy with what your ask and get paid.
Disadvantage: You may be too high or low
for your area.
2. Workers' Compensation Fee Schedule
Advantage: It puts you in the 70th statistical
percentile for the state
Disadvantage: Your state may not pay for
these services or not include you in work comp. It may be too high or too low for the
3. What Insurance Companies Pay for the Service
Advantage: It is supposed to reflect the
Usual Customary and Reasonable Fees in area.
Disadvantage: This is supposed to be an
average in your area but many times the insurance company pays what they want
regardless of the average in the area.
Note: Contact a mentor in the area who is willing
to share the insurance company's Explanation of Benefits (EOB) with you.
Use an average of the companies EOB's.
4. Cost Per Patient
Advantage: It establishes the lowest
fee you can accept without going out of business.
Disadvantage: It may not represent the
highest fee schedule the market is willing to pay.
Note: The CPPv will be a combination of several
therapies on the office visit. Go to the Practice Calculator to compute your CPPv.
5. What Other Providers are Charging in the Area
Note: This is within a 5 mile radius around
your practice. Try to get 10 office fee schedules.
Advantage: It gives you an average of what the
market is currently paying.
Disadvantage: It may not reflect what the
market is willing to pay.
6. What the Market is Willing to Pay
Advantage: This is the truest meter of the
value the market places in your worth. If the market is willing to pay a million dollars for
your service, then get it.
Disadvantage: It is difficult to determine what
the market is willing to pay. Moving the fee schedule too much cause a lack of consistency