BEFORE CREATING A FEE SCHEDULE, THE CLINIC PRICE LIST NEEDS TO BE COMPLETED. IT IS MORE TIME CONSUMING TO CREATE A FEE SCHEDULE BY ADDING ONE CPT CODE AT A TIME, RATHER THAN COPYING ALL CODES FROM THE PRICE LIST AT ONCE.
The purpose of a Fee Schedule is to indicate the allowed amounts for a specific plan type, for a specific payer.
Fee Schedules are not a requirement to bill insurance. If you are unsure what allowed amounts are set forth by a payer, you DO NOT have to create a Fee Schedule for that payer.
When Fee Schedules are set up properly, the system will automatically write off the difference between the charged amount in your Price List and the allowed amount in the Fee Schedule.
Fee Schedules aid in the ability to more accurately calculate the patient’s/payer’s responsibility and balances for each CPT code. It will also help ensure that your Accounts Receivable Report is not falsely inflated.
It is recommended that you create a Fee Schedule for all payers that you are in network with and use their usual and customary fees.
It is also recommended that you create Fee Schedules to incorporate special situations where policy overrides would come into play for a specific insurance plan.
You will notice that the Fee Schedule buttons and columns are the same as within the Price List. We will not go over each area in detail as done in the Price List Article so please reference the Price List Article if more clarification is needed.
The only difference between the Price List set up and the Fee Schedule set up is the “Per Unit Amount” column. In the Fee Schedule, the “Per Unit Amount” should reflect the payers allowed amounts, NOT the amount a clinic charges per service unless there is not a lower allowed amount for that service.
Only one Fee Schedule can be added in a patient’s insurance snapshot. You are unable to add in a Fee Schedule for Primary Payer level and Secondary Payer level.
Fee Schedule allowed amounts will ALWAYS be lower than what the clinic charges for a service.
Note: Fee schedule amount is for write offs. The amount displayed on the HCFA is the price list amount for each charge (what the clinic charges for the service) and not the Fee Schedule price.
How to create a Fee Schedule
Step 1: Under Admin
Step 2: Fee Schedules
Step 3: You will select the “Copy from Price List” button.
Make sure the correct Price List is selected.
Step 4: Select the appropriate Payer from the drop down provided. If your payer is not within the drop down, it will need to be added into the system via Admin > Payers.
If you select the icon to the left, that looks like a piece of paper, you can add the payer without having to go back to Admin>>Payers.
Step 5: Provide a name for this Fee Schedule so you can easily reference the appropriate one when adding a Fee Schedule to the patient’s file. The name can be as detailed or as general as you need it to be.
Step 6: Then Select Save.
Once you have Selected Save, everything from the Price List will be visible.
You will go down the list changing the amounts you see, to the appropriate allowed amounts.
If a specific CPT code, such as a supplement does not have a lowered allowed amount, you will skip it.
Also, you will want to make sure that the correct Start Date, for the CPT code is applied. If the Start Date is AFTER a Date of Service you would like this to take effect on, you will receive an error that states:
CPT NOT ASSOCIATED WITH FEE SCHEDULE
When finished, you will select Save again.
Please keep in mind, if you add a CPT to the Price List in the future, you will have to add that CPT code to each fee schedule created.
- Support Information -
If you have any questions or need assistance with this process please contact Support by:
Live chat: Click the 'Support Portal' button in your main toolbar (on left-hand side), click the green 'Support' box in bottom right of screen.***This has the fastest response time***
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