Medical Fee Schedule — Healthcare Pricing and Tariff Management

What Is a Medical Fee Schedule?

A medical fee schedule is the pricing structure that defines how much a healthcare institution charges for each of its services. Unlike a standard price list, a medical fee schedule must manage multiple variables simultaneously: client type (insurer, corporate agreement, self-pay patient), service type (laboratory, imaging, consultation), seasonality, public holidays, and the specific contractual terms of each payer.

The complexity of healthcare pricing is exponential. A diagnostic center offering 500 procedures across 10 insurers, 5 corporate agreements, and seasonal rate variations can have thousands of price combinations. Without a system that manages this matrix dynamically, billing errors, revenue leakage, and contractual non-compliance become unavoidable.

Why It Matters in Healthcare

The medical fee schedule is the foundation of a healthcare institution's entire commercial operation. Proper management directly impacts:

• Per-service profitability: ensuring every procedure is billed at the correct price according to the payer's terms, protecting business margins.
• Contractual compliance: insurers and corporate agreements require negotiated rates; a pricing error can trigger payment rejections, deductions, or penalties.
• Operational agility: dynamic configuration allows mass price updates without manual intervention at each point of sale.
• Patient transparency: self-pay patients need to know costs before receiving care, and the system must correctly calculate copays when insurance coverage applies.
• Seasonal adaptation: for facilities with variable demand, the ability to adjust prices by season or holiday optimizes occupancy and revenue.

How Davix Relates to Medical Fee Schedules

The fee schedule module within the Davix Commercial Management System provides an advanced architecture for managing healthcare pricing complexity:

• Dynamic price list configuration with multiple variables: client type, agreement, seasonality, public holidays, and service category.
• Advanced tariff management across all facility verticals (laboratory, imaging, consultations, special procedures).
• Automatic copay and deductible calculation based on each insurer's contractual terms.
• Mass price updates with automatic propagation to all points of sale.
• Native integration with electronic invoicing to ensure every receipt reflects the correct price per payer.

If your healthcare facility needs to eliminate pricing errors and ensure compliance with every agreement, the Davix fee schedule system delivers the flexibility that healthcare complexity demands.