Fee Schedules

Information about Fee Schedules

Billing / Fee Schedules Deleting a Fee Schedule for a Payor

To delete a fee schedule for a payor:

  1. Navigate to the Billing module and select Service Codes
  2. Click the Defaults column button to filter the screen by the fee schedule and service codes associated with it
  3. This will direct you to the “Fee Schedules Rates” grid
  4. Click the gear icon on the right-hand side of the fee schedule and select Delete Default Date

This will delete the fee schedule only, and not the service code.

Click here to learn about the “Defaults” column in the Service Codes grid.

Billing / Fee Schedules How to Edit Default Rates

To edit default rates:

  1. Navigate to the Billing module and select Service Codes
  2. Click Fee Schedule Rates at the top of the grid
  3. To update default rates for fee schedules linked to insurance plans, click on the number under the Agreed column
  4. Click Save Changes at the top of the grid

Please note:

  • Agreed rates must be turned on prior to editing default rates
  • Billing entries already created will not reflect any changes that are made to the rates. Edit the agreed rate in each timesheet and save the timesheet

Click here to learn how to edit timesheets.

Billing / Fee Schedules Assign a Fee Schedule Based on Date

To assign a fee schedule based on the service date on a timesheet:

  1. Navigate to the  Billing module and select Service Codes
  2. Click the Fee Schedule Rates button
  3. Search for the fee schedule to edit and click the gear  icon under the Options column on the right-hand side
  4. Select Add Range
  5. Add your Rate and Agreed rate and choose the Start Date and End Date
  6. Click Add

Billing / Fee Schedules Assign a Fee Schedule Based on Location

To assign a fee schedule based on the service location on a timesheet:

  1. Navigate to the  Billing module and select Service Codes
  2. Click the Fee Schedule Rates button
  3. Search for the fee schedule to edit and click the gear  icon under the Options column on the right-hand side
  4. Select Add Modifier Group
  5. Give this modifier group a Name, choose a Location, optionally add Modifiers, and add your Rate and Agreed rate
  6. Click Add

Billing / Fee Schedules Link a Fee Schedule to Payors’ Insurance Plans

After creating a Fee Schedule, link it to the payor’s insurance plan.

To link a Fee Schedule to an insurance plan:

  1. Navigate to the  Billing module and select Fee Schedules
  2. Click the BY PAYOR tab
  3. Next to each payor insurance plan, click the No fee schedules  drop-down and select the Fee Schedule you want to associate each payor plan to
    • If an insurance plan is not displayed on the list, click add a new one at the top of the payors list
      • Click the Select a company  drop-down, to select the insurance company name
      • Click the Select an insurance company  drop-down, to select the plan name
      • Click the Select a fee schedule  drop-down, to select the fee schedule to link this payor plan to
    • Click Associate fee schedule
  4. After creating Fee Schedules, assign them to service codes. This ensures that the default fee schedule rate will automatically pull over when a timesheet is created with that particular authorized code
    • If you do not see the payor you are looking for, please contact your organization account to ensure the plan is approved by your organization

Billing / Fee Schedules Create a Fee Schedule

To create a new Fee Schedule:

  1. Navigate to the Billing module and select Fee Schedules
  2. Click + Add New on the top right corner
  3. Complete the form:
    • Name: enter the name of the Fee Schedule (E.g. United Healthcare)
    • Description: enter a brief description (E.g. All United Healthcare services)
    • Click the checkbox Is Active, to activate the code
  4. Click Save
  5. After creating a Fee Schedule, start link it to payors and attach it to service codes

Billing / Fee Schedules / Billing / Service Codes Add a Fee Schedule and Rate to a Service Code

Service Codes can be assigned to multiple Fee Schedules, based on the agreed payor rates. Service Codes must have at least one fee schedule attached, otherwise, a yellow warning  will be displayed to the left of the code. The default rate associated with the Fee Schedule is the rate an insurance company or private client will be billed for such service.

To assign Fee Schedule and a rate to a Service Code:

  1. Navigate to the Billing module and select Service Codes
  2. Click the gear   icon under the Options column on the right-hand side, and select Add Default Rate
  3. Click the Fee Schedule  drop-down and select the Fee Schedule you are associating to the code
  4. Enter the Rate, which is the amount you are charging for a specific service
  5. Enter the Agreed Rate, which is the rate negotiated with the insurance payor for the service. If you do not have agreed rates you can enter the Rate used above
  6. Click Add