Maintain Fee Schedule Amounts
With the Maintain Fee Schedule Amounts function, you can store facility and non-facility allowed amounts and alternate fees for each fee schedule. Since fee schedules are stored by effective date, you can maintain separate fee schedules for each year and insurance carrier and update the fee schedule whenever the allowed amounts change.
NOTE: Before using this function, you must complete the Fee Schedule Setup Process. If these steps are not completed, the fee schedules and automatic write-offs in Payment Entry will not function properly. Included in these steps is the Maintain Fee Schedules function. You must establish the fee schedules in Maintain Fee Schedules before you can manually add or change any fee schedule amounts.
Allowed Amounts
Allowed Amounts are amounts set by insurance companies as the maximum charge they will allow as 'reasonable and customary' for a procedure code whether performed in a facility or non-facility.
In Payment Entry, the difference between the billed amount and the allowed amount will be written off if:
- You have completed the Fee Schedule Setup Process properly.
- There is an allowed amount entered in the fee schedule (for Alternate Fees or Rate Schedules for Facilities or Non-Facilities).
Enter the fee schedule Allowed Amounts using one of the three following methods:
- Manually enter the amounts for the selected, established fee schedule.
- Copy the amounts from another fee schedule - Copy the Fee Schedules.
- Import the amounts - Import Fee Schedules. You should use this process to save large quantities of data entry time and ensure the accuracy of the data. This automatically loads the allowed amounts for every procedure code stored in your Procedure Code Table.
Alternate Fees
Alternate Fees are amounts (different from your practice's Normal Rate) that your practice decides to charge, for all procedures or a particular procedure, whether performed in a facility or non-facility.
NOTE: The only way these Alternate Fees will default in the Chg Amt field in the Procedure Entry Function is if you enter this specific Fee Schedule Code in the Fee Schedule field in the patient's Billing Information screen.
- Manually enter the amounts if your practice uses alternate amounts for procedures.
- If you performed the Copy the Fee Schedules function to copy the allowed 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.
Rate Schedules A-E
Your practice can also charge different allowed and alternate amounts within various rate schedules. For example, Dr. Smith and Dr. Jones may choose to charge more than the Normal Rate that the other providers in the practice have established. You must then assign a Rate Schedule to Dr. Smith's and Dr. Jones's doctor codes in the Doctor Code Table. You must also manually enter the higher rates in the corresponding Rate Schedule field in the Procedure Code Table, for each of the procedure codes.
Upon accessing this function, the Maintain Fee Schedule Amounts screen displays containing blank data fields.
NOTE: After you select a Fee Schedule Code and an Effective Date and type a Procedure Code, press the TAB key to view the fee schedule amounts. If you press the ENTER key, the screen will save and refresh with only the Fee Schedule Code and Effective Date displaying. This is due to an internal programming requirement and cannot be changed.
Data Field Information
