Risk Fee Schedule Updates effective July 1, 2010

Suburban Health Organization strives to maintain a fee schedule that is competitive with other managed care plans operating in the Indianapolis area. The SHO Risk Fee Schedule is reviewed each fall to determine if it is market competitive and any necessary changes are routinely implemented on January 1. This year it was discovered that the majority of managed care plans have made the following adjustments to their fee schedule:

1. 1. Moved to a place-of-service based fee schedule that reduces reimbursement for select CPT codes if the service is provided in a Facility vs. Office setting



2. 2. Established biotech and injectable drug pricing based on an Average Sales Price (ASP) versus Average Wholesale Price (AWP) methodology

Both of these adjustments are consistent with CMS reimbursement methodologies and are now accepted practice among commercial payers. The SHO Medical Advisory Committee and Board have approved these updates, and the SHO Risk Fee Schedule will reflect these changes effective July 1, 2010.

If you would like to request a fee update, please submit your list of top codes to:

MadelynD@suburbanhealth.com

Include the CPT code and your billed charge. Please limit requests to 50 codes or less.

Thank you for your participation.

Dave Lippincott, Director of Provider Contracting & Risk Services
Michelle Fantauzzo, Risk Services Consultant