TrueFee

A Better Approach to Fee Schedules

RefMed TrueFee is an innovative market-based approach to creating medical fee schedules for government agencies. Previous approaches have relied on amounts billed to private insurance companies or Medicare. Some attempts are made to “impute” the actual amount paid but until now, those amounts are just guesses.

TrueFee uses contracted payment amounts from private and public payers to set a fee based on what providers are actually being paid. This results in a more realistic fee that is fair and defensible to payers, providers and patients.

Current & Accurate Fee Data

RefMed creates the TrueFee schedule using private insurer data available through the Transparency in Coverage Rule and fee data available from other government agencies. This data is validated and curated to provide current contract amounts from all the major group health companies.

The group health contract data is then blended with prices from other sources to create a market price. All sources are prices currently accepted by providers so the blended price is a fair and defensible amount. The goal is to create a price for medical goods and services that is acceptable and attractive to providers while also being fair to employers and payers.

This blended price is available by geocode (first 3 digits of the zip code) so prices are relevant to the provider’s practice area.

Reduce Admin Burden

An added benefit of using contracted fee data as the basis for the workers comp fee schedule is the reduction in administrative burden due to extended negotiations between payers and providers. With an out of date or unreasonable fee schedule, providers and payers are forced to negotiate each service or item individually either in a contract by provider or on a bill-by-bill basis. Unlike Medicare, where the price is known and accepted by the provider when the service is rendered, pricing without fee schedules is an uncertain market.

TrueFee

A Better Approach to Fee Schedules

Current & Accurate Fee Data

Reduce Admin Burden

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