Updating Fee Schedules

Use this task to modify a fee schedule.

The fee schedule configuration includes information collected on the following tabs:

Step-By-Step Guide

Step

Instructions

Additional Information

1

From Fee Schedules page, select the fee schedule to be updated.

2

General Fee Schedule Information Tab

Click Update. The Fee Schedule: [name] page opens with the General Fee Schedule Information tab displayed.

Update the relevant information via the applicable steps below...

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 modify the ASA conversion factor, minute to time unit conversion, or the method used for rounding time units.

14

In the ASA Conversion Factor section, enter the value 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:

For the Solo Physician, enter the values for base units, time units, and physical status units.
For the Solo CRNA, enter the values for base units, time units, and physical status units.
To apply the 2010 CMS Teaching Rules, select the Use 2010 CMS Teaching Rules checkbox.

18

In the Directing/Directed Provider Billing section, complete the following:

For the directing and directed provider with Non-Supervising status, enter the values for base units, time units, and physical status units.
For the directing and directed provider with Supervising status, enter the values for base units, time units, and physical status units.

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 modify 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.

Only procedures for the current year can be added via the quick add. Use import to add codes for prior years.

Procedure codes can be updated by selecting the procedure from the list and clicking Update. Make the necessary changes and click Save.

Procedure codes can also be removed by selecting a procedure from the list and clicking Remove. Click Yes to the Remove Procedure confirmation pop-up window.

26

Open the Code drop down list and select the procedure being added.

To find a procedure, type the digits of the procedure code in the space provided. As you type, the first procedure that matches the digits typed becomes highlighted.
To see a procedure that is not visible in the list, use the scroll bar to scroll down the list.
To select a procedure, click on it.

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 update the anesthesia procedures listed in 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.

Only procedures for the current year can be added via the quick add. Use import to add codes for prior years.

Procedure codes can be updated by selecting the procedure from the list and clicking Update. Make the necessary changes and click Save.

Procedure codes can also be removed by selecting a procedure from the list and clicking Remove. Click Yes to the Remove Procedure confirmation pop-up window.

35

Open the Code drop down list and select the procedure being added.

To find a procedure, type the digits of the procedure code in the space provided. As you type, the first procedure that matches the digits typed becomes highlighted.
To see a procedure that is not visible in the list, use the scroll bar to scroll down the list.
To select a procedure, click on it.

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::

Select the Override time unit calculations for this procedure checkbox.

Specify the following intervals for the segments:

Option	Description
First	Specifies the number of minutes in a segment and time unit size used to calculate that segment from the start of an anesthesia procedure. To define an override to the standard time unit, leave the number of minutes at zero (0) and enter the time unit size. For example, the standard time unit is 15 for the procedure, but the payer requires 12. Enter 12 in the second space of the first segment.
Next	Specifies the number of minutes in the second segment and time until size used to calculate that segment from the end of the first segment.
Remainder	Specifies the number of minutes in the third (remaining) segment and time unit size used to calculate that segment from the end of the second segment.

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 or updated.

42

Click Apply.

43

Miscellaneous Tab

Click the Miscellaneous tab to update the modifier details or time based fee calculations.

44

(Optional) To create a flat fee based on the two character modifier(s) present on a procedure in the Flat Fee by Modifier table:

Click Add. The Add Flat Fee by Modifier window opens.
Enter the 2 character modifier in the Modifier field.
Enter the flat fee in the Fee field.
Click Save.

You can also modify a Flat Fee by Modifier by selecting the modifier from the list and clicking Update. The Update Flat Fee by Modifier window opens.

Enter the updated details and click Save.

45

(Optional) To create a percentage fee based on the two character modifier(s) present on a procedure in the Fee Calculation Percentage table:

Click Add. The Add Fee Calculation Percentage window opens.
Enter the 2 character modifier in the Modifier field.
Enter the percentage calculation in the Fee Calculation % field.
Click Save.

You can also modify a Fee Calculation Percentage by selecting the modifier from the list and clicking Update. The Update Fee Calculation Percentage window opens.

Enter the updated details and click Save.

46

(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: