Set Up: Fee Schedules Available in HTML5

Release 6.2

“it just makes sense” July 2019

Table of Contents

Fee Schedule Types and Fee Schedule ....................................................................................... 1

Step 1: Create Fee Schedule Types ......................................................................................... 4

Step 2: Create Transaction Types ........................................................................................... 7

Step 3: Create a Fee Schedule .............................................................................................. 11

Assigning Fee Schedules ........................................................................................................... 12

Assign a Fee Schedule to an Employer Plan ........................................................................... 0

Assign a Fee Schedule to a Responsible Party ........................................................................ 4

Assign a Fee Schedule to a Doctor .......................................................................................... 4

Assign a Fee Schedule to a Location ....................................................................................... 5

Assign a Fee Schedule to a Practice ........................................................................................ 6

Adjusting a Fee Schedule Amounts ............................................................................................ 7

Importing a Fee Schedule ........................................................................................................... 9

1

Fee Schedule Types and Fee Schedule If your office is under contract with multiple insurance plans, a fee schedule specific to that plan can save time and improve accuracy over researching and inputting this information manually. While fee schedules are typically used for Pedo clients, Ortho clients will use fee schedules to make Financial Arrangements that will be available in a future HTML5 release. You can create as many fee schedules as necessary for your office and assign them to one of the following levels:

• Employer Plan

• Responsible Party (RP)

• Doctor

• Location

• Practice

When creating a Fee Schedule, you must decide which level you are going to create it for Examples include:

• An insurance company may provide you with amounts that it expects you to charge your patient. This would be an Insurance Fee Schedule that might be assigned to the policy.

• If your practice has specific amounts to charge a patient, it would be a Practice Fee Schedule.

The primary steps when creating a fee schedule are:

1. Create the applicable Fee Schedule Types:

• Insurance – All

• Insurance – Default & Charge

• Insurance – Charge & Copay

• Insurance – Default to UCR

• Insurance – Copay

• Insurance – Charge

• Insurance – Default & Copay

• Insurance – Is UCR

2. Create Fee Schedule Transaction Types, which include the following two types:

• Contract Transaction Type

• Fee Schedule Transaction Type

3. Create a Fee Schedule.

2

This document covers the following features:

• Step 1: Create Fee Schedule Types

• Step 2: Create Transaction Types

• Step 3: Create a Fee Schedule

• Assigning Fee Schedules

o Assign a Fee Schedule to an Employer Plan

o Assign a Fee Schedule to a Responsible Party

o Assign a Fee Schedule to a Doctor

o Assign a Fee Schedule to a Location

o Assign a Fee Schedule to a Practice

• Adjusting a Fee Schedule Amounts

• Importing a Fee Schedule

In addition, the following decision tree shows how fee schedules will work in your practice. You might want to print out this decision tree to assist you in setting up your Fee Schedules properly.

3

4

Step 1: Create Fee Schedule Types

A fee schedule type controls how the fee schedules work when applied to the Employer, Responsible Party, Doctor, Location or a Practice. Access: Edit > Setup > Fee Schedule Types > Add Fee Schedule Type dialog box

FIELD DESCRIPTION

Description The name of the fee schedule type.

Code The unique identifier of the fee schedule type.

Is UCR Checked for your UCR fee schedule. Typically, you will only have one UCR fee schedule. It is for practice fees.

Default to UCR Checked on all other fee schedule types other than Is UCR. This is a safety net; if you don’t have a fee for a specific code, Cloud 9 will put in the UCR amount. If you missed putting on a code, Cloud 9 defaults to UCR, instead of showing $0.

Use Chargeable Amount Checked when you have a copay plan. For example, the total charge is $100; insurance pays $50 and the patient pays $50. No percentages are involved.

Use Patient Copay Checked to indicate the fee schedule should use the patient copay on the fee schedule. When checked, additional check options are available. If checked, this column displays for fee entry on the fee schedule.

Copay Notes: If this box is checked on the fee schedule type, any amounts entered will not display in a column on the Financial Arrangement. There is NOT a column for Copay amounts. They will, however, be added to the Patient Share amount.

5

The most common fee schedule types and settings include the following:

Fee Schedule Type Settings

Insurance – All

Use the chargeable amount and patient copay; if not listed, then use the UCR amount

Insurance – Default & Charge

Use the chargeable amount; if not listed, then use the UCR amount

Insurance – Charge & Copay

Use the chargeable amount and apply the patient copay

6

Fee Schedule Type Settings

Insurance – Default to UCR

Use the UCR amount if no other amount is listed

Insurance - Copay

Use the patient copay

Insurance – Charge

Use the chargeable amount

7

Fee Schedule Type Settings

Insurance – Default & Copay

Use the Patient Copay; if not listed, use the UCR amount

Insurance – Is UCR

Use the UCR

Step 2: Create Transaction Types

There are two types of transaction types:

• Contract transaction type that automatically places the CDT code in the contract and on the claim form.

• Fee Schedule transaction type

8

Step 2.1 Create Contract Transaction Type

1. Access: Edit > Setup > Transaction Types > Add. The Add Transaction Type dialog box displays.

2. Enter the following fields: Type Code; Description and Category.

3. Select the following options and any other applicable options:

• Is Contract Note: The Is Contract Default Payments field is optional. If applicable, enter the number of payments typically associated with this transaction. This will display on the Financial Arrangement as well as the standard financial contract but can be modified.

• Is Optional in FA to be an optional choice in the Financial Arrangement.

4. Click the Transaction Code tab. The Add Transaction Type dialog box displays.

5. Click Add . The Add Code dialog box displays.

6. Click Search. The Choose a Code dialog box displays.

7. Select the desired CDT Code and click Select.

9

8. Enter the amount and click OK. The completed Add Transaction Type dialog box displays.

9. Click Save. When this transaction type is used to create a contract, the CDT code automatically displays:

• In the Contract

10

• On the Claim Form

Step 2.2 Create a Fee Schedule Transaction Type

1. Access: Edit > Setup > Transaction Types > Add. The Add Transaction Type dialog box displays

2. Enter the following fields: Type Code; Description and Category.

3. In the Code field, click Search. The Choose a Code dialog box displays.

4. Select the desired Code and click Select. Note: You cannot access the Amount field and the Transaction Codes tab. The fee schedule will determine the amount of the transaction.

5. Select Is Contract. Note: Is Contract Default Payments field is optional to enter the number of payments typically associated with this transaction.

6. Select any other applicable descriptions for the transaction type.

7. Click Save. This transaction is available to be added to a Fee Schedule.

11

Step 3: Create a Fee Schedule

Recommendation: The first fee schedule your office should create is an UCR fee schedule. This will help save you time because you can import the UCR fee schedule for other fee schedules you create. Then you can customize the other fee schedules – add individual entries; delete entries and add all transaction codes not already on the fee schedule.

FIELD DESCRIPTION

Name Name of the fee schedule.

Type The applied fee schedule type.

Parent If this fee schedule is a subset or a ‘child’ of another fee schedule, select the applicable parent. This fee schedule will be applied first and then go back to the parent fee schedule for additional transactions.

Order The fee schedule list order.

Filter The applied location for this fee schedule. The default is all locations.

Entries

Fee Schedule Tools

The ability to apply fee adjustments.

12

FIELD DESCRIPTION

Open transaction type lookup and select a transaction type.

Add all transaction types to the fee schedule that are not already on the fee schedule.

Delete a fee schedule entry.

Import fees from another fee schedule.

1. Access: Edit > Setup > Fee Schedules > Add. The Add Fee Schedule dialog box displays.

2. Name Field: Enter the desired name for the fee schedule.

3. Type Field: Select the fee schedule to be applied to this fee schedule.

4. Parent Field: If this is a subset or ‘child’ of another fee schedule, select the parent fee

schedule.

5. Order Field: Enter the number for the order this fee schedule should display on the list.

6. Filter Field: If applicable, select the desired location for this fee schedule.

7. Use the buttons to add transaction types applicable to the fee schedule.

Open transaction type lookup and select a transaction type.

Add all transaction types to the fee schedule that are not already on the fee schedule.

Delete a fee schedule entry.

Import fees from another fee schedule.

8. Click Save.

Assigning Fee Schedules You can create as many fee schedules as necessary for your office and assign them to one of the following levels:

• Employer Plan

• Responsible Party

• Doctor

• Location

• Practice

0

Assign a Fee Schedule to an Employer Plan

From the Patient’s Insurance Tab 1. Home > Add or Edit > Open the patient

2. Click the Insurance tab.

3. Click Add. The Add Insurance dialog box displays.

4. From the Fee Schedule field, click Search. The Choose a Fee Schedule dialog box displays.

1

5. Select the applicable Fee Schedule by one of the following methods:

• Selecting the Type of fee schedule from the dropdown list in the Type field.

• Entering a Name in the Name field, clicking Search and selecting the desired fee schedule.

• Paging through the fee schedules and selecting the desired fee schedule. 6. Once the desired fee schedule is selected, click Search. The selected fee schedule

displays in the Fee Schedule field.

7. Enter the other information on Add Insurance and click Add. The insurance entry displays on the Insurance tab.

Assign a Fee Schedule to an Employer Plan Through Setup

Adding a New Employer

1. From the Edit menu, click Setup.

2. Click Add. The Add Employer dialog box displays.

3. Enter Name, Addresses and Contact Info.

2

4. In the Employer Plans section, click Add Employer Plan. The Add Employer Plan dialog box displays.

5. Enter Plan Name, Billing Center, Group Number and Plan Notes (if applicable).

6. From the Fee Schedule field, click Search for Fee Schedule. The Choose a Fee Schedule dialog box displays.

7. Use the search tools – Type, Restrict to UCRs and Name – to narrow your search, and click Search.

8. Select the desired Fee Schedule and click Select. The Fee Schedule is updated on the Add Employer Plan dialog box.

9. Click Add. The Employer Plan is added on the Add Employer dialog box.

10. Click Save to save the employer information.

Editing an Existing Employer

1. From the Edit menu, click Setup.

2. Click the Employers.

3

3. Use the Search field to locate a specific Employer Name.

4. Select the Employer and click Edit for an existing employer. The Edit Employer dialog box displays.

5. In the Employer Plans section, select (highlight) the plan and click Edit Employer Plan. The Edit Employer Plan dialog box displays.

6. From the Fee Schedule field, click Search for Fee Schedule. The Choose a Fee Schedule dialog box displays.

4

7. Use the search tools – Type, Restrict to UCRs and Name – to narrow your search, and click Search.

8. Select the desired Fee Schedule and click Select. The Fee Schedule is updated on the Edit Employer Plan dialog box.

9. Click Edit. The Employer Plan is updated on the Edit Employer dialog box.

10. Click Save to save the updates.

Assign a Fee Schedule to a Responsible Party

1. Home > Add or Edit > Open the patient.

2. Click the Relationship tab.

3. Click the Responsible Party that is the subscriber.

4. From the Fee Schedule field, select the applicable Fee Schedule.

Assign a Fee Schedule to a Doctor

1. From the Edit menu, click Setup.

2. Click Employees.

3. Select the doctor for which the Fee Schedule will be applied to.

4. Click Edit. The Edit Employee dialog box displays.

5. Click the Insurance tab.

6. From the Fee Schedule field, click Search for Fee Schedule. The Choose a Fee Schedule dialog box displays.

7. Use the search tools – Type, Restrict to UCRs and Name – to narrow your search, and click Search.

8. Select the desired Fee Schedule and click Select. The Fee displays on the Insurance tab.

5

Assign a Fee Schedule to a Location

1. From the Edit menu, click Setup.

2. Click Locations.

3. Select the location the fee schedule will be assigned to and click Edit. The Edit Location dialog box displays.

4. Click the Insurance tab. The Insurance tab displays.

5. From the Fee Schedule field, click Search for Fee Schedule. The Choose a Fee Schedule dialog box displays.

6. Use the search tools – Type, Restrict to UCRs and Name – to narrow your search, and click Search.

7. Select the desired Fee Schedule and click Select. The Fee displays on the Insurance tab.

6

8. Click Save.

Assign a Fee Schedule to a Practice

1. From the Edit menu, select Practice Information.

2. Click the Insurance tab. The Insurance tab displays.

3. From the Fee Schedule field, click Search for Fee Schedule. The Choose a Fee Schedule dialog box displays.

7

4. Use the search tools – Type and Name – to narrow your search, and click Search.

5. Select the desired Fee Schedule and click Select. The Fee displays on the Insurance tab.

6. Click Save.

Adjusting a Fee Schedule Amounts When editing a fee schedule, you have the option to adjust fee amounts by a dollar or percentage amount. This enables you to do a bulk update to all fee entries on a fee schedule instead of individually updating each entry.

1. From the Edit menu, click Setup.

2. Select Fee Schedule.

3. Select the desired fee schedule to be updated and click Edit. The Edit Fee Schedule dialog box displays.

4. Click Fee Schedule Tools. The tools display.

8

5. In the Amount Type field, select which amount you want to update: Allowable; Chargeable or Patient.

6. In the Adjust Fee field, enter the desired adjustment to the fee by dollar amount or percentage – a number followed by “%”, P or p. Examples: Dollar Amount - $1; Percentage Amount – 50%; 50P or 50p

7. In the Round By field, select $1.00; $0.10 or $0.01.

8. Click Apply. The fees are adjusted.

9. After reviewing the changes, if you want to NOT apply the fee adjustments, then click Reset to return the fee amounts to their original values.

9

Importing a Fee Schedule If you ‘ve created a fee schedule that could apply to another fee schedule with minor modifications, importing a fee schedule is a quick and easy way to accomplish this.

1. Edit > Setup > Fee Schedule > Add (Fee Schedule). The Add Fee Schedule dialog box displays.

2. Enter the Name, Type and Order.

3. In the Filter field, if applicable, select the location this fee schedule should be applied to.

4. Click Import fees from another Fee Schedule . The Choose a Fee Schedule dialog box displays.

5. Select the desired fee schedule and click Select. The procedures and related information display on the fee grid.

6. Click Save.