Charges and Expected Reimbursement

This article is an overview of how charges and procedure codes are managed and how expected reimbursement by payer is tracked in Clinicient Insight. Detailed User Guides on Fee Schedules and Reimbursement Schedules are linked at the end of this article.

Overview of Fee Schedules

Allowed Procedure Codes (CPT Codes) and the fees charged for the procedure codes are managed in the Fee Schedule editor. Most payers will use the same fee schedule, which is usually named the Commercial Fee Schedule. Some payers use non-standard procedure codes and will need to have their own unique fee schedule.

From the Billing menu, select Fee Schedules. The Fee Schedule dialog displays.

The following is an example of a fee schedule that could be used for payers that use standard CPT codes exclusively.

Some payers will need their own fee schedules because they use some non standard procedure codes in addition to or instead of the standard CPT codes.

For example, a CRVPL (cervical pillow) has been added and the code type is set to Supply. The therapist sees the CRVPL code in documentation but it is billed out as E1399. Here is an example:

Allowed reimbursement may be tracked for each individual payer, or for groups of similar payers. Expected reimbursement amounts by procedure code should be entered into the payer's Reimbursement Schedule based upon contractual agreements or the payer's published payment amounts.

From the Billing menu, select Expected Reimbursement Schedules. The Expected Reimbursement Schedules dialog displays.

The allowed payment by payer is tracked in the Expected Reimbursement Schedule:

Detailed information about using the Fee Schedule Editor and Expected Reimbursement Editor are available in the links below:

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