Overview

The Fee Schedule: New and Fee Schedule: [name] pages are comprised of six tabs:

The General Fee Schedule Information tab collects general information about the fee schedule and associates payers and plans to the fee schedule.

See the Configuring Fee Schedules topic for additional details.

How to Get Here?

To open the General Fee Schedule Information tab for new fee schedule:

From the Home Page:
From the Menus:
Via Shortcut Keys: 
  1. Click Fee Schedules from the Admin list.
  2. Click Create.
  1. Open the Admin menu and select Fee Schedules.
  2. Click Create.
  1. From the Fee Schedules page, press [Alt] + [C].


To open the General Fee Schedule Information tab for existing fee schedule:

From the Home Page:
From the Menus:
Via Shortcut Keys: 
  1. Click Fee Schedules from the Admin list.
  2. Select the fee schedule to be modified.
  3. Click Update*.

*Alternate Navigation: Double-click the fee schedule from the list.

  1. Open the Admin menu and select Fee Schedules.

  2. Select the fee schedule to be modified.

  3. Click Update*.

*Alternate Navigation: Double-click the fee schedule from the list.

  1. From the Fee Schedules page, select the fee schedule to be modified.
  2. Press [Alt] + [U].

 

(Click an image below to enlarge.)

Fee Schedule: New Page / General Fee Schedule Information Tab

Fee Schedule: [name] Page / General Fee Schedule Information Tab


Field Definitions

Field

Type

Required

Description

General Section


Fee Schedule Type

Display Only

(pulled from created/updated Fee Schedule)

Yes

Identifies if the fee schedule is

  • Billing - Contains the fee structure for the following procedure types: anesthesia, medicine  services, pathology and laboratory, radiology services, surgery, and pain management, including professional modifier (26) and technical modifier (TC). This fee schedule contains the fees for services, conversion factors, modifiers, and relative value units (RVU).
  • Expected - Contains the expected payment for the following procedure types: anesthesia, medicine  services, pathology and laboratory, radiology services, surgery, and pain management, including professional modifier (26) and technical modifier (TC). This is often used for calculating the allowed amount expected for services rendered to an insured of a specific payer. This fee schedule contains the flat rates and fees that are not going to be calculated by the billing fee schedule.
Fee Schedule Name

Free Text

Yes

The name of the fee schedule as established in the fee schedule configuration. The name must be unique.

To make the fee schedule easy to identify, use the year the fee schedule is effective.

Multi-practice groups should include the practice abbreviation in the name to easily identify with which practice it is associated.

Description Free TextNo

The purpose of the fee schedule. Includes any additional information about the fee schedule to make it easy to identify.

This field is limited to 1000 characters.
Effective DateDate (mm/dd/yyyy)Yes

The date the fee schedule starts calculating charges. This date may be prior to the date you begin using the Connect platform. The effective date must be the earliest date which charges will be recorded in Connect Back Office.

Expiration DateDate (mm/dd/yyyy)No

The date the fee schedule is no longer used to calculate charges. Typically, this date is the expiration date of the payer contract.

ArchiveCheckboxNo

If checked, the fee schedule is archived and does not display in the list of fee schedules.

Archived fee schedules can be accessed by searching for archived items via the Status field in the Search Criteria window.

Medicare Locality Drop Down NoThe Geographic Practice Cost Index (GPCI) used to calculate fees related to charges submitted to Medicare based on geographic location. If left blank, fees are not calculated based on GPCI. If applicable, select the geographical location from the list. The list is maintained from the list provided by CMS.
Calculated Fee Rounding Drop DownYes

The method used for rounding the calculated amount for the RBRVS conversion factor. By default, this option is set to Do not round calculated fee amounts. The options include:

  • Do not round calculated fee amounts (default) - The fees for the calculated amount will not be rounded. If the ASA or RBRVS conversion factors are more than two decimal points, do not select this option.
  • Round fees to nearest whole dollar - The fees for the calculated amount will be rounded to the nearest whole dollar.
  • Round fees to nearest dime - The fees for the calculated amount will be rounded to the nearest dime.
  • Round fees up to next whole dollar - The fees for the calculated amount will be rounded up to the next whole dollar.
RBRVS Conversion Factor 

Free Text

(Positive, Numeric)

Yes

The flat fee rate of the conversion factor for relative value units. You can enter up to four decimal places, for example, 10.1230. This value will be multiplied by the number of relative value units (RVU) designated in the procedure. For example, suppose the RBRVS conversion factor is 100.00 and the relative value units is 13.6100. The fee for the procedure will be calculated as $1361.00.

If the practice does not use 100 to calculate fees for general procedures, you can enter the average conversion factor for the entire practice.

  • If you modify the RBRVS conversion factor in a billing fee schedule, cases with charges for non-generated claims are automatically updated with the appropriate values based on this factor.

  • If you modify the RBRVS conversion factor in an expected fee schedule, use the Recompute button to update the expected fee amount on cases. All cases will reflect the current RBRVS conversion factor, regardless of the claim status. After clicking this button, any payments not yet posted for the charges are updated with the recomputed expected fee amount, which is displayed on the payment in payment entry.

General Excise Tax (%) 

Free Text

(Numeric)

NoThe percentage value used to calculate plans including a general excise tax.
Related Payers & Plans Tab


Related Payers & Plans 

Display Only with Selection Checkboxes

(Pulled from created/updated Payers & Plans)

Yes

The list of payers and plans in Connect and association checkboxes. Checked payers and plans are linked to the billing fee schedule with fees calculated by the fee schedule.

At least one payer and one plan must be selected.

A plan can only be assigned to one fee schedule. If the plan is assigned to more than one fee schedule, an error message will display upon trying to save the fee schedule.

Special Compensation Days Tab

Tab is only available if the fee schedule type is set to Compensation.
Name

Display Only

(pulled from created/updated Fee Schedule)

NoThe name of the special compensation day.
Date

Display Only

(pulled from created/updated Fee Schedule)

NoThe date of the special compensation day.
Affiliated Practices Section


Affiliated Practices

Display Only with Selection Checkboxes

(Pulled from created/updated Practices)

YesThe list of practices in Connect and association checkboxes. A checked box next to a practice indicates the fee schedule is available for use on it. An unchecked box indicates the fee schedule is not available for use on it.




 

Related Topics

Fee Schedules

Fee Schedules Page

Fee Schedule / Anesthesia Billing Information Tab

Fee Schedule / General Procedures Tab

Fee Schedule / Anesthesia Procedures Tab

Fee Schedule / Miscellaneous Tab

Fee Schedule / Audit Tab

Configuring Fee Schedules

Updating Fee Schedules

Deleting Fee Schedules

Cloning Fee Schedules

Recalculating Fee Schedules



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