Pricing

The Plan Maintenance - Pricing tab maintains information about fee schedules and rate structures for a plan. The fee schedules and rate structures may be different for billed fees and rates and allowed fees and rates. As a result, this tab contains a tabbed dialog for Billed and Allowed. Since the information for billed and allowed fees and rates is the same, it is only documented one time and not repeated. Typically for contraced payors, on the Billed Tab a Fee Schedule and a Rate Structure are selected to be used to calculate Billed Amounts. On the Allowed Tab, an allowed Fee Schedule and allowed Rate Structure are selected to be used to calculate Allowed Amounts.

A list of Fee Schedules by effective and expiration date is maintained. If a plan has different fee schedules by staff member, facility, or a combination of staff and facility, add each necessary combination with the appropriate fee schedule. You do not need to add fee schedules for staff, facility, or staff and facility unless there are different fee schedules.

Effective Date	Effective date of the fee schedule. This will be the SERVICE DATE that this fee schedule becomes effective.
Expiration Date	Expiration date of the fee schedule. This will be the SERVICE DATE that this fee schedule expires.
Division	Division to vary fee schedule by if needed. Leave blank if all divisions use the same fees.
Locality	Locality to vary fee schedule by if needed. Leave blank if Localities are not used or if all Localities use the same fees.
Facility	Facility to vary fee schedule by if needed. Leave blank if all Facilities use the same fees.
Staff	Staff member to vary fee schedule by if needed. Leave blank if all staff use the same fees.
Fee Schedule	Fee Schedule to be used for the plan.

The use of Division, Locality, Facility and Staff are "weighted" from least specific (Division) to most specific (Staff). The weights are cumulative when used in combination. For example, a combination of Division and Locality will override an entry with Staff only.

New	Add a new Fee Schedule to the plan
Edit	Change a Fee Schedule on the plan
Delete	Delete a Fee Schedule from the plan

A rate structure is a set of rates per unit to be used for the calculation of anesthesia charges. A list of Rate Structures by effective and expiration date is maintained. If a plan has different rate structure by division, add each division with the appropriate rate structure. You do not need to add rate structures for every division unless there are different rate structures.

Effective Date	Effective date of the rate structure. This will be the SERVICE DATE that this rate structure becomes effective.
Expiration Date	Expiration date of the rate structure. This will be the SERVICE DATE that this rate structure becomes effective.
Division	Division to vary rate structure by if needed. Leave blank if all divisions use the same rate.
Locality	Locality to vary rate structure by if needed. Leave blank if Localities are not used or if all Localities use the same rate.
Facility	Facility to vary rate structure by if needed. Leave blank if all Facilities use the same rate.
Rate Structure	Rate Structure to be used for the plan.
Anesthesia Time Preference	The Anesthesia Time Preference that is used for the plan. This should be filled in for the anesthesia time calculations to perform correctly.

The use of Division, Locality and Facility are "weighted" from least specific (Division) to most specific (Facility). The weights are cumulative when used in combination. For example, a combination of Division and Locality will override an entry with Facility only.

New	Add a new Rate Structure to the plan
Edit	Change a Rate Structure on the plan
Delete	Delete a Rate Structure from the plan