Fee Schedule Best Practices

Fee Schedule Best Practices

Default Charge Fee Schedules

  • Always maintain a Default Fee Schedule with all Providers, Facilities, Insurances, and Plans selected (unless Fees only come from an Interface).
  • This acts as a fallback when no specific match exists, preventing missing or $0.00 fees during Charge Entry.

Relative To Fee Schedules

  • Use Relative To Fee Schedules to tie Payer rates to a base schedule with percentage adjustments.
  • This reduces maintenance effort by automatically updating dependent Fee Schedules when the base schedule changes.

Fee Schedule Upload Formatting

  • Follow the CSV formatting requirements when uploading Fee Schedules, including correct columns and consistent formatting.
  • This ensures successful uploads and prevents missing or invalid data.

Effective and Expiration Dates

  • Set relevant Effective and Expiration Dates.
  • These dates contribute to which Fee is pulled based on the Date of Service.

Procedure Code Library

  • Add Procedure Codes to the Procedure Code Library before creating Fee Schedules.
  • If a Procedure Code does not exist in the Procedure Code Library, uploading a new fee schedule will not add it.

Procedure Codes and Modifiers

  • Always maintain a base Fee for each Procedure code without a Modifier, and add Modifier-specific Procedure Fees separately.
  • The System checks for Procedure Codes with Modifiers first, but needs a base Procedure Code as a fallback.

Monitor Allowed Fees

  • Regularly run the Allowed Fee Exception Report to compare expected vs. actual reimbursements.
  • This helps identify underpayments, overpayments, and contract variances to protect revenue.


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