Creating the Fee Schedule

Transcription

1 There are three parts to setting up fee schedules using the RVU updater. 1. Creating a new fee schedule or copying an existing fee schedule 2. Using the RVU updater to update the procedure codes associated with a particular fee schedule. 3. Assigning the fee schedules to the providers. Creating the Fee Schedule Fee schedules are created in Administration. (Alt + F + O + D). Select Edit, Fee Schedule (Alt + E + L) To bring all fee schedules into view select the search button, select the F3 key on the keyboard, or select Alt + S. Create a new fee schedule by selecting the word New (Alt + N) or copy an existing fee schedule by selecting the word Copy (Alt +O). Page 1 of 17

2 Creating a New Fee Schedule Select the New button (Alt N) Enter the name of the schedule. Place a dot in the circle in front of RVU for Fee and/or Allowed. Use the drop down menu to tell the system to round the amount to the nearest penny, nickel, dime, or dollar. Add a note that reflects the contract or criteria used to set up the fee schedule. Select OK to accept the new Fee Schedule.. Copy a Fee Schedule Page 2 of 17

3 Select the fee schedule to be copied and then select Copy (Alt O). Rename the fee schedule. Change the Round Fees by and/or Round Allowed by fields if appropriate. Select OK. Page 3 of 17

4 When the dialog box returns, highlight the new fee schedule and select the Edit button. Set the information as if for a new fee schedule. Place a dot in the circle in front of RVU for Fee and/or Allowed. Use the drop down menu to tell the system to round the amount to the nearest penny, nickel, dime, or dollar. Add a note that reflects the contract or criteria used to set up the fee schedule. Continue on with instructions for new fee schedule. Once the Fee Schedule has been created or copied, select the Conversion Factors tab. Page 4 of 17

5 A dialog box will open that shows all departments set up in the database. This is the place where the conversion factor can be set for the fee and the allowed. The conversion rate can be different for the fee and for the allowed. The conversion fee may also be different between departments. For instance Office Visits may have a conversion rate for the fees of 2x Medicare conversion factor but surgery may have a conversion rate for the fees of 3x Medicare conversion factor. Select Edit. (Alt E) and add the conversion factor for the fee and/or allowed. Select Next (Alt N) to move to the next department and add the conversion factors. Continue on until all departments have been filled in. Select Ok to accept. Page 5 of 17

6 If the same conversion rate is to be used for all departments, Right click the column heading and select Fill Down from the drop down menu to quickly fill in the conversion rate for all departments. Page 6 of 17

7 Using the RVU Updater Setting up Fee Schedules with RVU Updater From the main menu select the Reports Component. (Alt F, O, R) Open the Reports Folder by clicking on the Plus sign in front of the folder. Open the Value Pack Reports Folder. Select the RVU Updater Folder. Select the RVU Updater Report. Page 7 of 17

8 Step 1 Search for and select the Fee Schedule to be updated. Select the RVU year that you wish to use for updating the fee schedule. These tables are based on Medicare RVU tables for each year and/or quarter.. Page 8 of 17

9 Decide if procedure codes will be updated for Nonfacility or for Facility Codes. Add the GPCI Locality for your area if needed. Drop down the menu, highlight and select the appropriate GPCI Locality Before the RVU values can be added to the system, a row must be added for each procedure code for the RVU value to land in. In the function field, select Create New Rows from the drop down Menu. Decide if updating Fees and Alloweds, just Fees, or just Alloweds with the criteria that has been selected. Check mark the appropriate boxes. Preview the report to view the rows that will be created. Page 9 of 17

10 Close the preview. This is an active report which will update the database. A dialog box will open which asks the end user if they would like to update the database. Yes, updates the database. No returns the user to the Reports Component without updating the database. The rows for the RVU s to land in have now been created. Step 2 The RVU values will be added to every procedure in the database for which a row was created. Page 10 of 17

11 Selecting Update RVUs in FS is the preferred selection. This will add the RVU value to the procedure on the Fee Schedule tab in Administration. Selecting Update Proc RVUs will update the fee field on the information tab of the procedure in Administration. Open the drop down menu in the Function Window. Select Update RVUs in FS. Then place a check mark in the appropriate category for the chosen criteria. Fees and Alloweds may be updated using the same criteria or can be updated separately using different criteria for each. Global periods for procedures may be updated for this fee schedule based on the criteria selected. Preview the report. The CPT codes will now have an RVU value attached based on the criteria used. Page 11 of 17

12 Close the preview. This is an active report which will update the database. The dialog box appears. Selecting Yes will update the fee schedules. Selecting No will return the user to the report selection screen. To see the changes that were made in the Fee Schedule, select Administration (Alt F,O,D). Then select Edit (Alt E), Procedures. Page 12 of 17

13 Type a procedure code in the Search Table and select Search (Alt S or F3). Highlight the selected CPT Code and select Edit (Alt E). Select the Fee Schedule Tab Select and highlight the Fee Schedule that was created or copied and renamed. Select Edit (Alt E). Page 13 of 17

14 The procedure code will have a value in the RVU fields. This RVU value will be multiplied by the conversion fee that was set up on the fee schedule to compute the Comp. Fee and the Comp. Allowed Values. These values are the new fees and/or allowed for the procedure for this fee schedule. The dots are shown in Fee Schedule instead of RVU as at the time the Fee Schedule was created, the selection of RVU was chosen. The marks on Fee Schedule indicates that the fee and/or allowable were set up according to the dictates of the fee schedule created in Administration. Assigning the Fee Schedule to the Providers Open the Administration component. (Alt F, O, D). Select Edit, Responsible Providers (Alt E,O). Page 14 of 17

15 Select the magnifying glass or use the F3 key on the keyboard to return all Responsible Providers. Highlight the first Responsible Provider that will be using the new fee schedule. Select Edit. (Alt E) Select the Billing Fee Schedule Tab. Page 15 of 17

16 Select the New button (Alt N) Select the company and/or Facility if Fee Schedule is only used for certain companies and/or facilities. Otherwise leave fields as All. Select the Insurance Carrier or Insurance Group that will be associated with the New Fee Schedule. Leave the Financial Class as All. Select the Fee Schedule to associate with the physician. Add an effective date to let the system know when to begin using the new fees. Select Ok Page 16 of 17

17 The fee schedule will be added to the Responsible Provider screen giving him permission to bill with the updated fee schedule. Continue editing providers who will be billing with the New or Updated Fee Schedule. Page 17 of 17