Fee Schedules Details

The Fee Schedule Maintenance - Details maintains individual procedure items of a Fee Schedules. Procedures that should be added to the Fee Schedule include procedures with flat fee amounts, either billed or allowed. Typically a "Standard" Fee Schedule is maintained for Flat Fee Billing Amounts, and separate "Allowed" Fee Schedules are maintained for different contracted payors. In addition, procedures that need special overrides, such as modifier overrides, file insurance option overrides, anesthesia time preference overrides, overrides for HCFA Box 24G, base unit overrides, or concurrency overrides, may all be added to a Fee Schedule. The Fee Schedules are tied to the Plans on the Pricing tab of the Plan Setup.

Practice

The current practice is displayed

Fee Schedule

Fee Schedule selected is displayed

Procedure

Enter/Select the procedure to be added or edited

Report As

Enter the procedure description to report on statements

Flat Fee

Enter the flat fee amount of the procedure.

A true "Flat Fee" from the Fee Schedule skips the anesthesia unit calculation entirely. If you need anesthesia units as well as a "flat fee", you should use the Plan ASA Override. You can set the Minimum Fee and Maximum Fee to the fee amount and, in effect, bill the ASA Code as a "flat fee", but with anesthesia units.

RBRVS Units

Enter the RBRVS Units of the procedure

Other Units

Enter the other (Relative Value) Units of the procedure

Modifier 1

Enter/Select the default primary modifier of the procedure

Modifier 2

Enter/Select the default secondary modifier of the procedure

File Insurance

Enter/Select the File Insurance option of the procedure. This setting will override the setting in both the Procedure Setup and the HCFA tab of the Plan Setup. Options include:

•	File Claim - to file paper or electronic according to Procedure Setup or the Plan setup.

•	File Claim - Paper Only - to override both the Procedure Setup and the Plan setup and always force a claim to file to paper; to not allow it to be sent electronically.

•	Do not File Claim - to override both the Procedure Setup and the Plan setup so that no claim is created at all.

•	If the field is left BLANK, the claim will be filed according to the Plan setup, or the Procedure Setup if an override has been specified there.

HCFA Box 24G

Select the HCFA Box 24G options for the procedure. This setting will override the setting in both the Procedure Setup and the Plan Setup. Options include:

•

Quantity

•

Minutes

•	Total Units

•	Time Units

•	Base Units

•	All Units Except Base

•	If the field is left BLANK, the claim will be filed according to the Plan setup, or the Procedure Setup if an override has been specified there.

Exclude from Concurrency

Indicates if this procedure is excluded from concurrency processing. If selected to be excluded, it will not be counted in overlaps on other cases, and will not be updated by concurrency (i.e. the modifier nor the medical direction will be modified on the case with this procedure). If checked, this flag overrides the Exclude from Concurrency flag in the Procedure Setup. If un-checked, the flag in Procedure Setup will override.

Do Not Update Concurrency

Indicates if the procedure is included in concurrency processing for the purposes of calculating the "overlap" of other cases, but the case that this procedure is on will not be updated by concurrency (i.e. the modifier nor the medical direction will be modified on the case with this procedure). If checked, this flag overrides the Do Not Update Concurrency flag in the Procedure Setup. If un-checked, the flag in Procedure Setup will override.

This is done sometimes on OB C-Section Cases where the carrier wants no concurrent case modifier, but the case should be included with all other concurrent cases for the purposes of calculating the number of overlapping cases. Performing the concurrency update would put a modifier on the case and excluding it from concurrency altogether would affect the concurrent case count of other cases.

Bill Zero $ Charges

Indicates if the Fee Schedule Detail will force the billing of zero dollar fees even if the File Zero Fee Charges on Claims on the Practice Claims Tab normally excludes these charges from claims.

This is a feature of PQRI processing where "Pay for Performance" procedures need to be billed.

Capitation Carve out

Indicates if this procedure is excluded from capitation and is always processed as fee-for-service.

Override Default Anes Times

Indicates if this procedure will use a different Anesthesia Time Preference from that assigned to the plan.

(Blank)

Enter/Select the Anesthesia Time Preference to use for the procedure if it is different from the one assigned to the plan.

This tab is used to force the override of a procedure so that, for example, base units will be pulled on a flat fee calculation.