How to find out insurance reimbursement rates by CPT code

[JeanettePNP, MSN, RN, NP]

I know how to look up Medicare reimbursement rates on their website. But how do you get this information for individual insurance companies.

I get paid a salary and don't have anything to do with billing directly, but I would still like to have a better idea what my services are actually worth.

[TX RN]

Ask your employer for a copy of EOB's.

This should list each patient and what rate is reimbursed by payor source.

You can review each charge.

[JeanettePNP, MSN, RN, NP]

Another question.

Once I am credentialed through my work with an insurance company, is that only for as long as I hold this job? If I change jobs, will I have to start the credentialing process all over again? (Assuming that they accept the same insurances.)

[itsmejuli]

I used to work for a medical insurance company.

Reimbursement is not at all simple. There are many contracts and rarely are they straight forward.

These contracts are also confidential information.

[RainMom]

Any ins company you are credentialed with should have supplied you with a CPT list with allowed fees. Also if you are friendly with your billing dept, a good CPT book (updated yearly) will give RVU (relative value units) for each code. Multiplying the RVU by your region's assigned "value" will give a suggested ballpark fee for each code. Comparing your calculated fee to what an ins will actually pay will help you decide if being in-network is worth it.

[TX RN]

Another question.

Once I am credentialed through my work with an insurance company, is that only for as long as I hold this job? If I change jobs, will I have to start the credentialing process all over again? (Assuming that they accept the same insurances.)

Yes.

You are credentialed through the groups number. You essentially receive a billing number that is tied to the groups practice.

If you leave the practice you will need to restart the credentialing process for your individual number.

[cayenne06, MSN, CNM]

And THIS is a big reason why health care costs are out of control in this country. Not only are consumers prevented from finding out exactly how much a hospital or provider charges for a service, the provider HERSELF often has no idea how much the service costs! This is crazy!

(hope it's clear this isn't a dig on you, OP. Billing should be straightforward for both patients and clinicians- it's crazy that you would have to consult multiple resources and do algebra to come up with a "ballpark" price for your services!)