Managing Fee Schedules

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1 Managing Fee Schedules What is a Fee Schedule? A list of fees (other than standard fees ) for services Most commonly used to post PPO allowable fees Why use a Fee Schedule? True estimates on Walkouts and Treatment Plans Accurate statements Improved collections Correct production numbers on reports Show actual (true) production numbers every day Improved goal tracking Transparency *Patients will have a better understanding of finances Trust *Patients will trust what you are telling them. Acceptance *Patients are more likely to accept treatment. How to Create a New Fee Schedule 1. Go to Lists Fee Schedule List New 2. Name your fee schedule (e.g. Delta PPO) 3. Start entering your service codes and insurance allowable fees 1 P a g e

2 Automatically Setting Up All Service Codes This will bring in all service codes, even inactive codes. Any unnecessary codes will need to be deleted from the list and any codes w/out a fee should be deleted as well. Example Scenario: You are contracted w/an insurance company but they did not include a fee for a certain code. Do not leave this code w/out a fee in your fee schedule list. Remember, the fee listed here is the fee that will be charged out. If it s on the fee schedule as 0.00, that is what will post in the walkout and treatment plan. Delete this service code from the list. Any codes not listed in the fee schedule will default to your full standard fee when used in a walkout or treatment plan. 2 P a g e

3 Individually Setting Up Service Codes With this option you will have to manually add each service code and allowable fees. This option is preferred because you won t have to go back and delete any inactive codes or any codes not included in the fee schedule. Utilizing an Existing Fee Schedule After you have created your first fee schedule use this option to create the rest. The fee schedule you just created becomes a template (service codes from that fee schedule will be automatically pulled in) and you will only need to update allowable fee on each service. Attaching Fee Schedules Fee schedules can be applied to a patient or an employer. Fee schedules applied to a patient will affect only that patient. Fee schedules applied to an employer will affect all patients with that employer. *Note: Fee schedules attached to a patient will always override any fee schedules attached to an employer. Employer: 3 P a g e

4 Patient: Preferences File Preferences Accounting preferences Standard fee and adjustment will show during the walkout and treatment plan creation. The standard fee and adjustment will also display in the account ledger. *For the office Walkout/Treatment Plan w/accounting preference checked: Walkout/Tx Plan w/accounting preference un-checked: 4 P a g e

5 Completed services as they appear in the account ledger Preference checked (top image) vs. un-checked (bottom image): Insurance preferences Standard fee and adjustment will show on walkout statements and treatment plan printouts. *For the patient Smart Invoice - Preference checked (top image) vs. un-checked (bottom image): 5 P a g e

6 Treatment Plan Printout - Preference checked (top image) vs. un-checked (bottom image): Employer preferences Allow you to choose to bill standard fee on claim form (for the insurance company) To update this preference per Employer: Edit Employer Preferences Check Bill Standard Fee on Insurance Claim 6 P a g e

7 To update this preference for any NEW Employers entered from this point forward: Go to File Preferences Employer Tab Check Bill Standard Fee on Insurance Claim To update this preference for all existing Employers: Go to Utilities Mass Updates Global Employer Preferences Update Bill Standard Fee on Claim 7 P a g e

8 Reports Analyze the following reports on a regular basis: Managed Care Utilization Managed Care Analysis Service Codes by Fee Schedule 8 P a g e

9 Updating Fee Schedules Go to Lists Fee Schedule List Edit the Fee Schedule that needs to be updated Update the allowable fees and select OK to save. *Note: Exclusive use is required when updating treatment plan fees and updating OnSchedule fees (fees for services attached to an existing appointment). Allowable fees can be updated during the day while everyone is working, simply uncheck the two boxes at the top and click OK to save changes. If later, you wish to update fees on existing treatment plans and appointments, simply edit the fee schedule, leave both boxes checked and click OK to save. For more information on fee schedules, visit and type fee schedule into the search by keyword field. 9 P a g e