Introduction to Fee Schedule Setup

Background

Please see this article for background information on setting fee schedules and expected reimbursement: Charges and Expected Reimbursement.

Important Considerations

  • You should not need to create very many fee schedules. Most organizations have one or two.
  • One fee schedule may be assigned to multiple payers.
  • It is rarely necessary to create a new fee schedule "from scratch". If you have existing fee schedules, you may copy them, rename them, and edit them.
  • There is usually only one fee schedule earmarked for guarantors. At least one Guarantor Fee Schedule must be named Default to accommodate some billing rules. If you have more than one Guarantor Fee Schedule, you will be able to choose which Guarantor fee schedule needs to be associated with each case in the Guarantor tab.

Creating a New Fee Schedule

Use the following procedure to create a new fee schedule:

  1. From the Billing menu, select Fee Schedules. The Fee Schedule Editor dialog displays.
  2. Click New Schedule. The Add/Edit Fee Schedule dialog box appears.
  3. Enter a unique name for the new fee schedule in the Name field.
  4. Enter the fee schedule effective date in the Effective Date field. (This date must be on or before the date of your first charges.)
  5. Click Save to save your changes and close the Add/Edit Fee Schedule dialog.
  6. If the fee schedule will be a guarantor fee schedule, select the Guarantor Fee Schedule check box.
  1. Activate the new fee schedule by selecting the Active check box.

    Note: Click Copy Version to create a new version of an existing fee schedule. This is used when you want to increase or decrease your charges.

  1. Click Add, then select a charge code and charge amount as illustrated here:

Assigning Allowed Reimbursement

Please see Expected Reimbursement for background information.

After saving the newly created fee schedule, you are prompted to edit Allowed Reimbursement amounts for all associated payers. After entering all of the codes in the fee schedule, you are prompted to edit the charge amount to reflect the allowed reimbursement amount for all associated Allowed Reimbursement Schedules:

Note: By default, the system assigns the charge amount as the allowed reimbursement for any new procedure codes entered into a fee schedule.

After entering all of the procedure codes and charges a fee schedule should look something like this:

Using Charge Ranges

To enter charges when a defined range of charges and fees are required, click Use Range and enter the Range in Charges allowed where indicated. When processing charges with ranges, the fee will need to be entered.

Note: When the Is Variable check box is selected, there is no defined range for the charge code. The fee must be entered during charge processing.

Variable Charges

It is rarely necessary to create a new fee schedule from scratch. More often than not, if a new fee schedule is needed, it can be copied from an existing fee schedule, then edited.

Use the following procedure to copy an existing fee schedule and edit it.

  1. Click Copy Schedule .
  2. Make any necessary edits in Charge Amount and Fee Amount columns on the existing line items.
  3. Add or delete any Charge Codes and Bill As codes as needed.
  4. Declare whether or not this will be a Guarantor Fee Schedule.
  5. When you are finished, click Save to save your changes and close the dialog box.

Enter the name of your fee schedule and select the effective date.

Note: See Assign Fee Schedules for information on how to associate fee schedules with payers.

Fee Schedule Change Log

Insight now provides a change log that tracks the clinic's fee schedule. In addition, a record of the initial fee schedule is provided. This change log is intended to provide you with information about fee schedule codes that have changed and by whom.

To access the Fee Schedule Change Log, perform the following steps.

  1. From the Billing menu, select Fee Schedules. The Fee Schedule Editor dialog displays.
  2. Click Change Log. The Fee Schedule Change dialog displays.
  3. Select the Fee Schedules tab to view changes made to Fee Schedule settings.

The following table defines the fields contained in the Fee Schedule tab.

Field Description
Fee Schedule The name of the fee schedule
Field The names of the fields associated with a fee schedule
OldValue The initial value of the field. Information shows in this field only when a field value has changed
NewValue The current value of the field
User The person who entered the initial or changed value
Modified The date that the change was made
  1. Select the Fee Schedule Versions tab to view changes made to a fee schedule by Fee Schedule name.

The following table defines the fields contained in the Fee Schedule Versions tab.

Field Description
Fee Schedule The name of the fee schedule
Field The names of the fields associated with a fee schedule.
Old Value The initial value of the field. Information shows in this field only when a field value has changed.
New Value The current value of the field.
User The person who entered the initial or changed value.
Modified The date that the change was made.
  1. Select the Codes tab to view changes made to the Fee Schedule billing codes.

The following table defines the fields contained in the Codes tab.

Field Description
Fee Schedule The name of the fee schedule
Effective Date The date that the fee schedule becomes effective.
Billing Code The initial value of the field. Information shows in this field only when a field value has changed.
Field The names of the fields associated with a fee schedule.
Old Value The initial value of the field. Information shows in this field only when a field value has changed.
New Value The current value of the field.
User The person who entered the initial or changed value.
Modified The date that the change was made.
  1. Select the Codes By Range tab to view fields that can have a range value populated.

The following table defines the fields contained in the Codes by Range tab.

Field Description
Fee Schedule The name of the fee schedule
Effective Date The date that the fee schedule becomes effective.
Billing Code The initial value of the field. Information shows in this field only when a field value has changed.
Field The names of the fields associated with a fee schedule.
Old Value The initial value of the field. Information shows in this field only when a field value has changed.
New Value The current value of the field.
User The person who entered the initial or changed value.
Modified The date that the change was made.
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