Procedure code fees are entered into fee schedules. There are three types of fee schedules.
- In network (normal).
- Patient copay per procedure (copay).
- Out of network (out of network/allowed)
Typically you will create a fee schedule for your Usual Customary and Reasonable (UCR) fees and for each insurance company you are contracted with. A fee schedule can allow a single (global) fee per procedure, or allow provider and/or clinic-specific fees. See Enter Procedure Code Fees. For an explanation of how a patient's fee schedule is determined, see Fee Schedule Logic. Users must have the Edit Fee Schedule permission to access the Fee Schedule window.
- From the main Procedure Code List click Fee Scheds in the lower right, or in the Main Menu, click Setup, Fee Schedules
Fee schedules that already exist are listed. To only show fee schedules of a certain type, select the Type in the upper right. The sort order here determines the sort order when selecting a fee schedule throughout the program.
- Up/Down: Reorder the fee schedules. Select a fee schedule, then click Up or Down to move it.
- Sort: Quickly sort the fee schedule list alphabetically by type (Normal first, then CoPay, then Out of Network)
- Click Add or double click an existing fee schedule to edit.
- Description: Enter the name of the fee schedule.
- Select the type. This property cannot be changed once the fee schedule is created. See Insurance Plan Types for more examples of when to use each type.
- Normal = In network fee schedules. These types of fees schedules are options in the Fee Schedule dropdown on the Edit Insurance Plan Window.
- Copay = A fee schedule for patient copays per procedure. These types of fee schedules are options for Patient Co-pay Amounts on the Edit Insurance Plan window. When selected this fee schedule will override the patient portion of an insurance estimate. A co-pay fee schedule can have just a few fees on it with the rest blank. Blank amounts will not affect ordinary insurance estimates. But if the co-pay fee schedule has any amount, including zero, it will override ordinary insurance estimates.
- Out of Network (formerly called Allowed) = A fee schedule for fees allowed by insurance, even if you are not contractually obliged to follow them. These types of fee schedules are options for Carrier Allowed Amounts on the Edit Insurance Plan window. When computing estimates, all percentages will be based on this out of network amount instead of on the procedure fee. Blank amounts are ignored and will not change the estimates. But out of network amounts of zero will result in an estimate of zero. Out of network fee schedule entry can be automated using the Blue Book feature.
- Use Global Fees: Set whether the fee schedule will only allow a single (global) fee per procedure, or allow provider and/or clinic-specific fees.
- Checked: Only allow a single fee per procedure.
- Unchecked: Allow provider and/or clinic specific fees per procedure. This box can only be changed when the logged-on user has the Provider Fee Edit permission and, if Clinics is turned on, Headquarters is selected in the main menu. See Provider and Clinic-Specific Procedure Fees to enter fees.
- Click OK to save.
A fee schedule cannot be deleted, but can be hidden as a selection option as long as it is not associated with a provider or patient. On the Edit Fee Schedule window, check Hidden.
Clean Up Allowed
This button is only visible to users with the Security Admin security permission. Use it to delete out of network fee schedules that are not being used or are attached to hidden insurance plans. It is sometimes useful if you have used the Blue Book feature.
Check Ins Plan Fee Schedules
This tool allow you to check that insurance plans have the correct fee schedules or reassign fee schedules for multiple insurance plans at once. Click Go to make sure that insurance plans have the correct fee schedule attached. See Check Ins Plan Fees.
Question and Answers
Q: How do I update fee schedules?
A: There are several ways including importing fees, increasing fees by a percentage, or manually entering fees. See Fee Tools.
Q: Can I reassign fee schedules for multiple insurance plans at once (e.g. when there is a new fee schedule and I want to keep the old fee schedule).
A: Yes - use the Check Ins Plan Fee Schedules tool.
Q: How do I print a fee schedule?
A: In the main menu, click Reports, Standard, then select the Procedure Codes / Fee Schedule Report.