Use this task to configure a fee schedule. Fee schedules contain the fee structures for calculating fees on specific procedures. Each fee schedule is identified by a unique name. Structure fee schedules for the services your practice provides and then use the appropriate fee schedule for calculating fees for services rendered.
There are two types of fee schedules:
- Billing
- Expected
Each practice must have at least one billing fee schedule and one expected fee schedule, but can have as many as needed to meet the requirements of its payers.
Billing Fee Schedules
Charges entered in Connect Back Office will be calculated by the billing fee schedule associated to the payer or plan. A typical practice will have two, possibly three, billing fee schedules—one for standard (non-contractual), one for Medicare, and one for Medicaid, if applicable. To determine the number of billing fee schedules you need for a practice, make a list of the payers who fall into the following categories:
- Time Increments - List all the payers that use time increments other than 15 minute increments. Create separate lists for each difference.
- Physical Status Modifiers - List all the payers that pay for physical status modifiers. Create separate lists for each difference.
- Rounding Factors - List all the payers that round fees differently. Create separate lists for each difference.
The list of categories becomes the number of billing fee schedules you will need to create in addition to the default billing fee schedule.
If the plan is configured for Team Billing, Bill Physician Only, create two fee schedules—one for billing the directing and directed billing provider at 100% and one for billing the directing and directed billing provider at the applicable percentages, for example 50% directing and 50% directed.
Expected Fee Schedules
The expected fee schedule is used for calculating the expected amount to be reimbursed by a payer for services rendered for specific procedures. Typically, the expected fee schedule contains only the procedure codes that will be charged a flat fee or percentage.
The expected fee is the amount that is expected to be received from the payer. If this fee schedule is assigned to a plan, this amount displays for those procedures entered in the expected fee schedule when charges and payments are entered in Connect Back Office. When entering a payment, you will be able to see an immediate comparison between the actual charge and the expected amount.
To determine the number of expected fee schedules needed for a practice, make a list of the payers and plans that fall into the following categories:
- Conversion Factors - List all the payers that use a conversion factor. Create separate lists for each difference.
- Flat Fees - List all the payers that are contracted to pay a flat rate for a particular procedure regardless of any other factor. Create separate lists for each difference.
- % of the Allowed - List all the payers that are contracted to pay a percentage of the allowed amount. Create separate lists for each difference.
The list of categories becomes the number of expected fee schedules you will need to create in addition to the default expected fee schedule.
The fee schedule configuration includes information collected on the following tabs:
- General Fee Schedule Information Tab
- Anesthesia Billing Information Tab
- General Procedures Tab
- Anesthesia Procedures Tab
- Miscellaneous Tab
Step-By-Step Guide
Step | Instructions | Additional Information | ||||||||
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| 1 | From the Fee Schedules page, click Create. The Fee Schedule: New page opens with the General Fee Schedule Information tab displayed. | |||||||||
| 2 | General Fee Schedule Information Tab Open the Fee Schedule Type drop down list and select the type of fee schedule being created: Billing, Expected, orCompensation. | |||||||||
| 3 | Enter the name of the fee schedule in the Fee Schedule Name field. | |||||||||
| 4 | Enter additional information to describe the purpose of the fee schedule in the Description field. | |||||||||
| 5 | Enter or select the Effective Date to begin calculating charged based on the fee schedule. | |||||||||
| 6 | (Optional) Enter of select the Expiration Date to stop using the fee schedule to calculate charges. | |||||||||
| 7 | (Optional) Open the Medicare Locality drop down list and select the geographical location if the fee schedule uses GPCI. | If you start typing in the field, the cursor jumps to the point in the list that matches the typing. | ||||||||
| 8 | Open the Calculated Fee Rounding drop down list and select the option for rounding the calculated amount for the RBRVS conversion factor. | |||||||||
| 9 | Enter the value to use as the conversion factor for relative value units in the RBRVS Conversion Factor field. | If you are updating an expected fee schedule with a different RBRVS Conversion Factor, click Recompute on the Fee Schedules tab after completing the modifications to the expected fee schedule. | ||||||||
| 10 | Enter the general excise tax rate in the General Excise Tax (%) field. | |||||||||
| 11 | In the Related Payer & Plans section, select the payer and its associated plans to be associated with the fee schedule. | |||||||||
| 12 | Click Apply. | |||||||||
| 13 | Anesthesia Billing Information Tab Click the Anesthesia Billing Information tab to specify the ASA conversion factor, minute to time unit conversion, and the method used for rounding time units. | |||||||||
| 14 | In the ASA Conversion Factor section, enter the value you want to use as the ASA conversion factor for the fee schedule in the Conversion Factor field. | |||||||||
| 15 | In the Minute to Time Unit Conversion section, enter the number of minutes that comprise a time unit. | |||||||||
| 16 | In the Time Unit Rounding section, enter the method to use for rounding time units. | |||||||||
| 17 | In the Solo Provider Billing section, complete the following:
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| 18 | In the Directing/Directed Provider Billing section, complete the following:
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| 19 | In the Supervising Provider Billing section, enter the values of the Base Units and Time Units for services provided by a supervising provider. | |||||||||
| 20 | To specify the Elective Physical Status Modifiers, enter the values for each physical status modifier (P1 through P5) that will be added to anesthesia procedures for elective cases. | |||||||||
| 21 | To specify the Emergency Physical Status Modifiers, enter the values for each physical status modifier (P1 through P5) that will be added to anesthesia procedures for emergency cases. | To set the P1 through P5 modifiers to the same values for emergency and elective cases, then select the Same as Elective checkbox. | ||||||||
| 22 | To specify the Custom Time Unit Rounding Point, enter the number of minutes that will be used as the interval for rounding time units. | |||||||||
| 23 | Click Apply. | |||||||||
| 24 | General Procedures Tab Click the General Procedures tab to specify which procedures are included in the fee schedule. | These steps detail adding procedure codes one by one. Refer to the Importing Procedure Codes topic for this process. | ||||||||
| 25 | Click Add. The Update General Procedure window opens.
| The current year populates the Year field. Only procedures for the current year can be added via the quick add. Use import to add codes for prior years. | ||||||||
| 26 | Open the Code drop down list and select the procedure being added.
| If the CPT Code contains an NDC Code, the NDC Code field will be populated accordingly. It can be updated as needed. | ||||||||
| 27 | (Optional) Enter a modifier in the Mod field. | |||||||||
| 28 | To override the calculated amount for a procedure performed in a facility, enter the amount of the override fee for the procedure when it is performed at a facility in the Override field in the Facility Amount section. | |||||||||
| 29 | To override the calculated amount for a procedure performed in a non-facility, enter the amount of the override fee for the procedure when it is performed at a facility in the Override field in the Non-Facility Amount section. | |||||||||
| 30 | (Optional) Click Save & Add Next to add additional procedure codes. Repeat the above steps for each procedure being added. | |||||||||
| 31 | Click Save once all procedure codes have been added. | |||||||||
| 32 | Click Apply. | |||||||||
| 33 | Anesthesia Procedures Tab Click the Anesthesia Procedures tab to add one or more anesthesia procedures to the procedures table. | These steps detail adding procedure codes one by one. Refer to the Importing Procedure Codes topic for this process. | ||||||||
| 34 | Click Add. The Update Anesthesia Procedure window opens.
| The current year populates the Year field. Only procedures for the current year can be added via the quick add. Use import to add codes for prior years. | ||||||||
| 35 | Open the Code drop down list and select the procedure being added.
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| 36 | To override the ASA base units, enter the amount of the override fee for the procedure in the Override field in the ASA Base Units section. | |||||||||
| 37 | To override the maximum minutes, enter the number of minutes for the override in the Maximum field in the Minutes section. | |||||||||
| 38 | To override the calculated time units, specify the override values via the Calculation Scale section fields (section is enabled upon selecting the Override time unit calculations for this procedure checkbox). | To complete this window::
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| 39 | To override the fee associated with the procedure, enter the new fee amount in the Override field in the Fee section. | |||||||||
| 40 | (Optional) Click Save & Add Next to add additional procedure codes. Repeat the above steps for each procedure being added. | |||||||||
| 41 | Click Save once all procedure codes have been added. | |||||||||
| 42 | Click Apply. | |||||||||
| 43 | Click Save to save and close the page. | |||||||||
| 44 | Miscellaneous Tab Click the Miscellaneous tab to specify modifier details or time based fee calculations. | |||||||||
| 45 | (Optional) To create a flat fee based on the two character modifier(s) present on a procedure in the Flat Fee by Modifier table:
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| 46 | (Optional) To create a percentage fee based on the two character modifier(s) present on a procedure in the Fee Calculation Percentage table:
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| 47 | (Optional) To specify the fee calculation based on specific time internals, select the Calculate fee by time interval checkbox and enter the applicable initial and subsequent interval quantities in the fields provided:
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| 48 | Repeat all of the above steps for each billing fee or expected fee schedule being created. |
Not applicable for this topic