Manage List - Payer - Add Fee Schedule

Follow the steps below to add a Fee Schedule:

Select the desired payer from the list.

• Navigate to the Action menu and choose Add Fee Schedule. A Payer Details screen will be displayed.
• Click on the pencil icon to add new payer details.
• Enter the desired Payer name and Payer ID in the appropriate fields.
• Click Save to add new payer details.
• The user can update the fee and other details for each code by clicking the pencil icon next to it.
• Update the necessary details and click Save to apply the changes.
• Using the Payer Details screen, you can perform the following actions:
  • Upload Bulk Payer Fee Schedule: Upload a fee schedule for multiple payers in bulk. Follow the instructions in the Upload Fee Schedule. 
  • Link to CMS Fee Schedule: Associate a payer's fee schedule with the CMS Fee Schedule. Follow the instructions in the link to the CMS Fee Schedule.
  • Delete Fee Schedule: Remove an existing fee schedule for the payer. Follow the instructions for Delete Fee Schedule.

Upload Fee Schedule

The user can upload the Bulk Payer Fee Schedule by following the steps below:

• Click on the Upload Fee Schedule. The Upload Bulk Payer Fee Schedules window will be displayed.
• Click on the Download Payer Fee Schedule File to download the .CSV fee schedule template and enter the required information in the appropriate fields.

Note: Do not modify the column titles or add/remove columns. Any changes will prevent the file from uploading successfully.

• Save the file on your local machine.
• Enter the desired file Name.
• The selected payer will be listed under the Payers field. 
• Select the desired Year and Quarter using the appropriate drop-down fields. 
• Click on the Upload area. Browse and select the saved .csv file.

• Click Upload & Link. The confirmation message will be displayed.
• Click Confirm. The uploaded payer will be listed on the main screen.
  • Note:
    • Users can upload payer-specific fee schedules or link to the preloaded CMS fee schedule. However, the system does not support using both a payer-specific fee schedule and the CMS fee schedule for a single payer.
• To switch from a payer-specific fee schedule to the CMS fee schedule:
  • Create a new unique payer and link it to the CMS fee schedule.
  • Alternatively, delete the payer-specific fee schedule and then link the CMS fee schedule.

The same process applies when switching from the CMS fee schedule to a payer-specific fee schedule.

The system uses the date of service and payer specified in the Audit Box to associate the appropriate fee schedule. This data is applied to select report parameters within audit guidelines and generate customized financial reports.

If no payer fee schedules are uploaded or linked to the CMS fee schedule, the system can only calculate financial data up to the work RVU level.

To Bulk Upload the Fee Schedule for multiple payers, navigate to the Payers Actions menu and select Link Custom Fee Schedule. 

Link to CMS Fee Schedule

The user can link to the CMS Fee Schedule by following the steps below:

• Select the desired Payer from the list. The Payer Details screen will be displayed.
• Click on the Link to the CMS Fee Schedule.
• Choose the desired Geographical Location and click Submit. A Confirmation message will be displayed, and codes will be listed on the screen.

Delete Fee Schedule

The user can Delete Fee Schedule by following the steps below:

• Select the desired code from the list.
• Click on the Delete Fee Schedule button. A confirmation message Delete Payer Fee Schedule, will appear.

• Click Confirm to proceed with deleting the fee schedule.

  Delete CMS Fee Schedule:

  • To delete the CMS Fee Schedule, click on the Delete Fee Schedule button directly without selecting any code.

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