---
title: Why You Need To Fix Your Pricing RIGHT NOW!
description: Why you need to fix your pricing RIGHT NOW!  If you have not increased your fees to reflect the 2021 E&M changes, you may be leaving money on the table.
image: https://chipsblog.pcc.com/hubfs/shutterstock_1470745211.png
---

# Why You Need To Fix Your Pricing RIGHT NOW!

February 19, 2021

[insurance](https://chipsblog.pcc.com/tag/insurance), [rvu](https://chipsblog.pcc.com/tag/rvu)

[As you should be aware](https://chipsblog.pcc.com/impact-of-2021-rvus-on-pediatricians), the 2021 RBRVS values have a significant impact on the relative value of some key procedures important to pediatricians, especially E&Ms.

Normally, annual RVU changes adjust the values of each code by incremental amounts.  This year, however, E&Ms have increased by more than 20%, which puts many pediatric practices in danger of leaving real money on the table.

Let's review the salient facts:

- I typically recommend that practices write off *at least* 20% of every EOB line-item charge.  Why?  Because many insurance contracts (which I AM SURE YOU HAVE HANDY) have little sneaky language in there that reads something like this: "We will pay you our fee schedule or XX% of your charges, *whichever is lower."  *That XX is often a number like 80% or 70%.
- Although most payors haven't flipped to the 2021 RVU values yet, Tricare, many Medicaid programs, and some private payors already have.
- If your pricing is such that- for example - your BCBS E&M charges are 20% higher than your fee schedule now, when BCBS turns on the 2021 values,  *you may not see the increased fees!*

Let's walk through an example using easy math.

2020 99213 Charge - $100  
2020 BCBC Payment - $75 (75% of your charges)  
2021 BCBC Payment - $90 (90% of your charges)

If BCBS will pay you their fee schedule or XX% of your charges, whichever is lower, you will lose money any time XX is more than 90%! [And I've never seen a 90% figure - it's always 60-80%.]  Do you see how when BCBS catches up to 2021, you may not know it?

Worse, a number of key pediatric procedures have *dropped* this year, so those payments will drop right away regardless of your charges.

We saw the same thing happen with the imms admin codes a few years ago and watched as pediatric practices were slow to update their fee schedules.  It's mid-February now, go to it.

If you're not a PCC client, you'll want to use the [2021 RVU Calculator](https://chipsblog.pcc.com/free-2021-rvu-calculator).  If you're a PCC client, you have this data in your system and can do the work yourself or call us to give you a hand.

 

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