Inside In Touch Biller Pro, you can set up your own fee schedules for different payers. The fee schedules help simplify the claim creation process, and are meant to be used as internal resources.
How do I set up my fee schedule in In Touch Biller Pro? What is the fee schedule and where do I set it up?
Fee schedules are available to help streamline the claim creation process by auto populating the fee associated with specific CPT code charges The fee schedules will never be sent to the insurance company(s), and are used as an internal reference only. During the claim creation process the Biller will have the option to edit charge amounts and override the fee schedule amount that auto populates if necessary.
To set up a fee schedule for your In Touch Biller Pro account, click on Administration at the top right hand side of the screen.
Under the Insurance & Billing column, click on Fee Schedule.
There are two types of fee schedules: charge fee schedules and expected fee schedules. Charge fee schedules auto-fill the fee for the CPT code, while expected fee schedules auto-fills the allowed amount and used in under payment reporting. For more information about adding and editing codes to a fee schedule in particular, review the “How to Add/Edit Codes to your Fee Schedule.”
The Fee Schedule Overview screen will display a list of existing fee schedules already created for your In Touch Biller Pro account.
The icons to the right allow you to:
- Edit a fee schedule
- Copy a fee schedule, which will copy the fee schedule settings, but allow you to change the title and fees as needed. This will help streamline the fee schedule creation process if you are using the same fee schedule settings for multiple payers.
- Delete a fee schedule
You also have the option to compare or reset a fee schedule on the list by checking the box of any fee schedule located to the right of the icons.
To add a new fee schedule, click on New Fee Schedule at the top right hand side.
Creating A New Fee Schedule
When setting up a new fee schedule, you will need to enter the following information:
1-Fee Schedule Information:
Enter a title.
Select Charge Amount or Expected Amount
-You also have the option of picking from a previously created template
2-Location Information:
Select Locality (based on Medicare)
-This only applies to those clinics with multiple locations.
3-Provider Information:
Select Providers. Highlight and click “Add.”
4-Insurance Profile Information:
Select Insurance Profiles:
Payer Class: This list is generated from the payer class options when adding an insurance profile in the patient chart.
Payer Name: This list is generated from the users list of payers within Payer Maintenance.
Plan Name: This list is generated from the plan names created in Payer Plan Maintenance.
Click “Next” at the bottom of the page when finished.
If you will be choosing a specific payer by Payer Name, you do not need to designate a Payer Class, simply choose All Payer Classes.
Note: You will be able to choose any payer from the list to assign a fee schedule to, even if enrollment is still pending for that Payer. Make sure that your Payer Maintenance List is correct, in order to avoid setting up a fee schedule for incorrect payers.
When you are done, make sure to click “Next“.
- Choose one from the templates: Medicare/ Total RVU/ Work RVU or Custom.
- Enter/save codes.
If Medicare/ Total RVU/ Work RVU is selected:
- Choose year.
- Choose Conversion Factor or Select Percent.
- Decide whether the fee schedule calculations will apply to all codes or choose select codes to apply the calculations to.
- Click “Save Fee Schedule.”
Note: Only codes from the Standard Medicare fee schedule are created. Lab and drug codes need to be added via the custom method.
RVU values are different for each State, if you do not know what your RVU rate is please refer to the 2013 Physician Fee Schedule for your State, provided by the Centers for Medicare & Medicaid Services.
If Custom is selected: There are three custom options available. CSV upload is the recommended option if a large number of codes need to be entered. Custom codes override the Medicare and RVU templates.
Click “Enter Carve Outs & Modifiers.”
- Superbill: Displays all codes from the billing slip (superbill) that has been created, and enter a value.
Manually enter codes:
- Enter code or description
- Click “Search”
- Select Modifier(s) (optional). This provides the user with the option to create multiple charge amounts for the same CPT, depending on the modifier selected.
- Enter fees.
- Click “Save.”
Continue adding codes and fees and when finished, click “Save Fee Schedule.”
- CSV Upload: Click “View sample file” for access to the template. Follow the instructions provided in the template.
Note: HealthFusion can assist with the CSV file upload. A minimal fee may be required.
Click “Save Fee Schedule” when finished.
- When adding fees to an existing fee schedule click, “Add More Fees.”
- When editing fees to an existing fee schedule click, “Edit.”