Summary
The program gives you a tremendous degree of flexibility with a rich, multi-layered structure for determining what fees accounts pay. The structure provides not just a number of fees schedules, but the ability to inject exceptions at many points. No single user organization uses all the types of schedules. They are included in the software for three reasons:
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To support the wide range of services offered by the clinics.
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To address various complexities of billing that arise because the laws and conventions for Workers' Comp billing which vary from state to state.
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To manage employer billing for contract services which is subject to pricing differences from both the Workers' Comp and the Usual & Customary schedules.
The Fee Schedules
The program provides three standard fee schedules, Employer Contract Services, Worker's Comp, and Private Practice/Urgent Care. These can be considered your "list prices", the fees you charge when no discounts are involved. Special fees can be also entered, associated with the Private Practice fee schedule, for providing discounts when Private Practice / Urgent Care visits are paid in full at the time of the visit.
Some multi-clinic enterprises span state lines. To allow them to easily comply with the Workers' Comp regulations in both states, the software allows entry of state specific fee schedules. If different fees are charged at different clinics for other reasons, the situations can usually be handled by entering clinic fee schedules. If you handle Medicare visits, a separate Medicare fee schedule can be entered.
You are not limited to using standard fees. You can also enter special pricing for an account. This can be an across the board discount, or it can be override fees set up for specific activities. Special pricing is set up on an exception basis when you create a billing account.
While a new fee schedule can take a while to enter, it comes into effect at a specific time. The program allows you to enter fees in advance, and them put them into effect at the designated time. Furthermore, you can import, export, and transfer fee schedules. This allows you to export the current fee schedule, update it with Excel or another program, then import the revised schedule. You can also transfer fees from one schedule to another. So, if you have entered a new Workers' Comp fee schedule and want to use the same one for Private Practice, you do not need to re-enter all the fees. Or if you have entered special fees for one employer and want to use the same with others, you can transfer instead of re-entering for each.
Do you need even more control of prices? If you make an arrangement with an employer to charge a specific fee for a certain activity when performed on one category of visit, but not on others, you can even put in a special price for the activity on a company specific visit category protocol. And, if you are billing a contract TPA or a lab for a range of services delivered to the company, you can enter a third party payer contract with its own special fees.
Figuring it All Out
While it is great to have all this control if you need it, it can all get very complicated! If you use complicated billing rules, you need to be very clear about which fee will be used in which circumstances since it is quite possible to have a situation where it appears that more than one special rule applies. For instance, if an employer has an across the board 7% discount, but also has a special override fee for one medical activity, how do you know which one takes precedence? Will the software use the discount? Will it use the override fee? Will it apply the discount to the override fee? (We'll tell you-it will use the override fee, but it will not apply the discount to it.) To help you sort all this out, two diagrams are provided that walk you through the many possible circumstances, and answers the questions Which Fee Will Be Used for Employer Services? and Which Fee Will Be Used for Workers' Comp?
Fee Tickets
the program provides a super bill (aka fee ticket) that can be set up to replicate your Workers Comp and Private Practice charge sheet. A master ticket for Workers Comp and Private Practice can be set up in the Clinic System Parameters, or a single override ticket can be set up for each Clinic, if you have different needs in different locations. The program includes a parameter to print the super bill immediately following the encounter form (except for employer physicals), and also to use it as the entry window when entering charge. See How to Set Up a Fee Ticket/Superbill and How to Enter Charges.
Standard Fee Schedules
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Employer services
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Workers' Comp services
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Usual and customary (Private Practice/Urgent Care) fee schedule
Special Fee Schedules
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Contract fee schedules
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State fee schedules
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Clinic fee schedules
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Network fee schedule
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Medicare fee schedule
See Also