Fee Schedule Setup Process

With Fee Schedules you can track the correct allowable for each insurance carrier, automatically calculate the allowed and write-off adjustment amounts during payment entry, and charge alternate amounts by insurance carrier (such as a non-participating amount for Medicare). You should only use fee schedules for insurance carriers you are contracted with and need to make insurance adjustments for the non-allowed amounts on patient accounts.

Setting up New Fee Schedules
The following steps should be performed to set up New Fee Schedules:
  1. Create Fee Schedules - Tables, Fee Schedule Table, Maintain Fee Schedules.

  2. Enter Fee Schedule Amounts - The individual fee schedule amounts should be entered for each procedure code using one of the three functions listed below:
  3. Enter Alternate Amounts - Tables, Fee Schedule Table, Maintain Fee Schedule Amounts. If your practice uses alternate charge amounts for procedures, you have to add these to the fee schedule manually. If you copied the amounts into your new fee schedule and the fee schedule you copied from already contained the Alternate Amounts, you do not need to perform this step.

  4. Update the Location Code Table - Tables, Location Code Table, Maintain Location Codes . Indicate whether the locations use facility or non-facility amounts. The standard default for each location code is set to 'non-facility', so you should only need to change those locations that use facility amounts.

  5. Link the Fee Schedule to the Insurance Carrier - Tables, Insurance Carrier Table, Maintain Insurance Carriers. It is necessary to add the applicable Fee Schedule to the Insurance Carrier if you want to keep track of the allowed amounts and have the adjustments automatically calculated in Payment Entry.

  6. Add the Fee Schedule to the Patient Account - Patient, Change Patient Data - Billing Information. The only time it is necessary to add a fee schedule to a patient's account is when you want to charge an alternate amount.

  7. Print the Allowable Comparisons Report - Tables, Fee Schedule Table, Print Allowable Comparisons. If you want to compare the amounts for the new fee schedule to another fee schedule, you can print this report. It will print the CPT Code, normal charge and allowed amount. This aids in contract negotiations and reasonable and customary appeals process.

  8. Update Fee Schedules in Payment Entry - Transactions, Payment Entry. After the initial setup has been performed, you can also update the Fee Schedule Allowed Amounts 'on-the-fly' during payment entry. In the Allow field, type in the new allowed amount followed by an asterisk (*) and this will update the Allowed amount in the Fee Schedule Table.


Updating Fee Schedules
There are two different methods available for updating your fee schedules. The first method should be used if your existing fee schedule contains 'Alternate Amounts' and the second method should be used if it does not.

Method 1 - Fee Schedule Contains Alternate Amounts
  1. Copy the Fee Schedule - Tables, Fee Schedule Table, Copy the Fee Schedules. Select the Fee Schedule you want to update, enter the old Effective Date and then the new Effective Date. This will automatically create the fee schedule with the new effective date and also copy the Alternate and Allowed amounts from the old Effective Date into the new Effective Date.

  2. Enter Fee Schedule Amounts - The individual fee schedule amounts should be updated for each procedure code using one of the two functions listed below:
  3. Update the Alternate Amounts - If you need to update any of the Alternate Amounts, you will need to do so manually - Tables, Fee Schedule Table, Maintain Fee Schedule Amounts.

Method 2 - Fee Schedule Does Not Contain Alternate Amounts

Note: If you plan on importing the current fee schedule, skip to the second section of Step 2 below - Import the amounts from a file.
  1. Copy the Fee Schedule - Tables, Fee Schedule Table, Copy the Fee Schedules. Select the Fee Schedule you want to update, enter the old Effective Date and then the new Effective Date. This will automatically create the fee schedule with the new effective date and also copy the Allowed amounts from the old Effective Date into the new Effective Date.

  2. Enter Fee Schedule Amounts - The individual fee schedule amounts should be updated for each procedure code using one of the two functions listed below:
  3. Print the Allowable Comparisons Report - Tables, Fee Schedule Table, Print Allowable Comparisons. If you want to compare the amounts for the updated fee schedule to another fee schedule, you can print this report. It will print the CPT Code, normal charge and allowed amount. This aids in contract negotiations and reasonable and customary appeals process.