PPS: Fee Schedule
Fee Schedule is a way for practices to set up a variety of charges for the same CPT code across the list of providers, by insurance company, without having to create a new code for each provider. Fee Schedule can also be used to keep track of the contractual write-off for each CPT code, which will aid in manual insurance payment entry as well as productivity estimations. This feature will not affect self-pay patients, or patients that do not have insurance coverage.
Fee Schedule introduces a way to bill a single CPT code with a variety of fees, based on the service provider and the insurance company. This means that a single transaction procedure code can be used for both the MD and Therapist. Additionally, Fee Schedule allows the CPT code to be assigned default modifier codes. Finally, Fee Schedule allows users to assign their Contractual Write-Off to all insurance billable CPT codes. These values will appear on the Apply Insurance Payment page, facilitating the manual entry of EOB data. This will also increase the accuracy of Estimated Productivity reports.
Note: Fee Schedule is a fairly complex addition to the system. Time should be taken to fully understand this feature as improper use can cause serious repercussions.
Valant Settings – Persons and Institutions | Insurance Companies
Before a practice can make effective use of Fee Schedule, they must create at least one Billing Type (Reference Data | Billing Types) and assign that Billing Type to their providers (Persons and Institutions | Providers).
To access the Fee Schedule for a particular payer:
- Click on Persons and Institutions | Insurance Companies
- Select a payer from the list
- Locate the Fee Schedule functionality by clicking on Options, located in the lower right corner, and choosing Fee Schedule
1. Click the New Fee Schedule button located in the upper right corner of the window
2. Enter a name for this Fee Schedule type. This name is a category header for this Fee Schedule and subsequent versions. A best practice is to label your Fee Schedules with a reference to the providers or Billing Types assigned to it. For example, if you have a Fee Schedule specific to therapists, you can include the word ‘Therapists’ in the name.
The Fee Schedule window is split into two areas:
- The top portion lists all of the Fee Schedules which have been created for this payer.
- The lower half of the screen displays all of the details for the selected Fee Schedule.
Fee Schedule – Upper Table
The upper portion of the window lists all the main types of Fee Schedules available, as well as alternate versions of each type. You can create more than one type of Fee Schedule only when your practice is using Billing Types. Otherwise, you will only be able to create a single, default Fee Schedule.
In the example above, the practice has two main types of Fee Schedules created for the payer. There is a default Fee Schedule called "Default", which is active January 1st through December 31st of 2013. The name of the default Fee Schedule appears in blue text. The default Fee Schedule is used when no other Fee Schedules are valid for the charge that is being created.
There is another Fee Schedule called ‘MD Fee Schedule’. This type of Fee Schedule has two different versions available. One version is active January 1st through December 31st, 2013, while the other is active January 1st through December 31st of 2014.
Each Fee Schedule type has an Action button located to the far right of the page. The options listed under the Action button vary depending whether the Fee Schedule type is the Default or not. Remember, the Default Fee Schedule is listed in blue text. The Action dropdown menu for the Default Fee Schedule is detailed below.
Note: You cannot assign a Billing Type to a Fee Schedule that is set as the Default. This is because the Default Fee Schedule applies to all providers, as it is used when no other Fee Schedules can be applied to a charge.
Action button options:
- New Fee Schedule Version: This creates a new version of that Fee Schedule type. It copies the details from the existing Fee Schedule type as a starting point for the new version. This option allows you to set up future instances of a Fee Schedule, such as anticipating contractual changes over time.
- Change Fee Schedule Name: This renames the Fee Schedule type.
- Show History: This displays the audit history of this Fee Schedule type.
If the Fee Schedule type is not the default, the options in the Action dropdown menu are slightly different. The two new items are detailed below.
- Set as Default: This sets the current Fee Schedule type as the Default. This means that this Fee Schedule will be used when none of the other listed Fee Schedules are valid for a given charge.
- Assign Billing Types: This option allows you to assign specific Billing Types to this Fee Schedule. The Billing Types must be assigned to providers under Persons and Institutions: Providers for the Fee Schedule to be used billing charges are created.
- Create New Version From This: Each sub-version allows you to create a new copy of the Fee Schedule, with the same Charges, Adjustments, and Modifiers as the original version. This was designed for creating copies of an existing fee schedule for a future date.
Fee Schedule – Lower Table
The lower portion of the Fee Schedule window displays the details of the Fee Schedule. Each row in the details is tied to a specific CPT code located in Transaction Codes: Procedures. Each CPT code has a Charge, POS Code, Contract Adjustment, validity marker, and up to four Modifier Codes that can be assigned.
Each CPT code also has an Audit history. This is available in the Action dropdown menu to the right. The resulting Fee Schedule CPT Code History window will list the complete audit history of this particular CPT code for this Fee Schedule.
Validating Procedure Codes in a Fee Schedule
Procedure codes listed in a fee schedule can be flagged individually as valid or invalid. Users with the authority to change a fee schedule are capable of flagging the procedure codes.
Leave any of the corresponding "Valid?" Checkboxes checked to make a procedure code valid. The entire column will be checked by default. Unchecking them will make them invalid. If a user attempts to save an appointment or a charge containing an invalid procedure code, an error message will be displayed. Add-on codes are not subject to the same validation checks as regular procedure codes. The checkboxes for them will be grayed out in the list.
Note: These validation checks will only be performed if the user has Enhanced Billing Validation (EBV) enabled in the Practice Preferences menu.
In addition to the CPT code line items, each Fee Schedule has a name and a date range. These dates are very important, as the system will only use a specific fee schedule if the service date of the charge falls within the range specified. If none of the Fee Schedules listed have an effective date that matches a particular charge, the system will use the default charge listed for the code under Transaction Codes | Procedures. If you want to use your fee schedule indefinitely, make the End Date 1/1/9999.
Note: This article contains proprietary information of Valant Medical Solutions. It is intended solely for the information and use of parties operating and maintaining the products described herein. Such proprietary information may not be used, reproduced, or disclosed to any other parties for any other purpose without the expressed written permission of Valant Medical Solutions.