Contract Fee Schedules (Allowables) in Partner
<support@pcc.com>
1 Main Street, Suite 7
Winooski, VT 05404
(800) 722-7708 Admin
(800) 722-1082 Support
Copyright © 2005, 2006, 2007 The Physician's Computer Company
2008/09/29 18:57:40
PRINTING INSTRUCTIONS: To print out copies of this document, browse to Contract Fee Schedules (Allowables) in Partner to download a PDF formatted version. Then select the "File" menu and choose the "Print" option. If you have trouble opening and printing the PDF, please contact PCC support at <support@pcc.com> or (800) 722-1082.
1. Introduction: Tracking Contract Schedules
Partner tracks contract fee schedules, also known as allowables, in the Contract Fee Schedule Editor (allowedit). After you enter fee schedules into allowedit, you can assign them to insurance plans in the Table Editor (ted). The Post Insurance Payments (pip) program will then display the contracted fee or "Allowed" amount when posting payments for charges pending those insurance plans.
Alternatives: If you wish to track and evaluate reimbursement levels without tracking allowables, you could accomplish the same goals by running a series of Partner reports. Smart Report Suite (srs) reports can examine reimbursement for individual or groups of insurance plans, for specific procedures, or by transaction. Contact PCC support or visit learn.pcc.com for more information.
2. Create and Edit Contract Fee Schedules
Use the Contract Fee Schedule Editor (allowedit) to create a schedule and add allowable fee amounts. Follow the procedures below. You can store several different contract schedules in your system and later assign them to relevant insurance plans.
2.1. Create a New Contract Schedule
Run the Contract Schedule Editor (allowedit)
From a command prompt, type allowedit. You can also have PCC support add allowedit to a Partner window.
Press [F5 -- Add New Schedule] to Create a New Schedule
Name Your New Schedule
Enter a name in the Schedule name field. Use a unique name based on the contract.
Press [F1 -- Process] to Save Your Schedule
Begin Adding Fees to Your Schedule
Use the up and down arrow keys to select your new schedule. Then use the function keys to add fee amounts or perform other functions. See the procedures below for more information.
2.2. Add Contractual Fees (Allowables) By Procedure CPT Code
Run the Contract Schedule Editor (allowedit) and Select Your Fee Schedule
Use the arrow keys to select the contract schedule to which you wish to add fees.
Press [F1 -- Edit By CPT]
Wait While RBRVU is Calculated
There will be a brief pause as Partner builds an RBRVU value list.
Enter a Procedure Code and Press Enter
Enter a CPT code in the Code field. You may have several related codes that also need to be set. Enter the base code.
Review Procedures and Existing Values
Every matching procedure for the code you entered will appear on the screen. Previous contractual amounts may appear along with activation dates.
Tools: Using the function keys at the bottom of the screen, you can change the year and percentage of the RVU calculation and recalculate, sort the list of procedures in different ways, jump down to a specific CPT, hide or show the former contract amounts, and edit historical fees. You can also press Page Down or Page Up to scroll through the list of procedures.
Enter New Fee Amounts and Specify Effective Date
In the fields provided, enter the new Contract Fee Amounts and the Effective Start Date of the amount.
Setting the Date: If you are entering contractual amounts that pertain to past dates of service, be sure and back-date the amounts to the date the contract became effective.
Automated Entry: After you add the first amount and date for the first item, allowedit will copy the information to the fields for the other CPT codes. Be sure and change any code entries that should not have the same amount and date.
Press [F1 -- Save and Restart]
Continue to the Next Code or Press F12 to Quit
Enter another CPT code to continue working, or press F12 to return to the Contract Schedule menu.
2.3. Add Contractual Amounts (Allowables) for All Codes
Run the Contract Schedule Editor (allowedit) and Select Your Fee Schedule
Use the arrow keys to select the contract schedule to which you wish to add fees.
Press [F2 -- Edit Full Schedule]
Wait While RBRVU is Calculated
There will be a brief pause as Partner builds an RBRVU value list.
Review Procedures and Existing Values
Every procedure in your Procedures table will appear on the screen. Previous contractual amounts may appear along with activation dates.
Tools: Using the function keys at the bottom of the screen, you can change the year and percentage of the RVU calculation and recalculate, sort the list of procedures in different ways, jump down to a specific CPT, hide or show the former contract amounts, and edit historical fees. You can also press Page Down or Page Up to scroll through the list of procedures.
Enter New Fee Amounts and Dates
In the fields provided, enter the new Contractual Amounts and the Effective Start Date of the contract.
Setting the Date: If you are entering contractual amounts that pertain to past dates of service, be sure and back-date the amounts to the date the contract became effective.
Press [F1 -- Save]
When you are finished entering fee amounts, press F1 to save your changes and return to the list of schedules.
2.4. Use the RBRVU/Medicare and BNA Calculation Features
The Update Schedule screen displays a column containing an estimated fee amount.
The amount is a calculation based on a percentage of Medicare's reimbursement with or without the Budget Neutrality Adjustment.
You can change three factors that determine what amounts will appear:
Medicare Year: If the contract you are entering is based on a specific Medicare year or you wish to compare your contractual fees to a specific Medicare year, enter the year at the top and press [F3 -- Recalculate RVU].
Percentage: If you are creating a contract based on a percentage of Medicare's reimbursement, edit the percentage colum and press F3.
Budget Neutrality Adjustment: If you need to see fee amounts with the BNA adjustment applied, set the BNA field to Yes and press F3.
You can learn more about RBRVUs and using Medicare reimbursement by visiting PCC.com or attending a PCC Users Conference.
3. Assign Contract Fee Schedules to Insurance Plans
After creating a Contract Fee Schedule and entering allowable amounts, you must assign the schedule to specific insurance plans. Follow this procedure:
Run the Table Editor (ted)
You can run ted from the Partner Configuration window:
You can also type ted from a command prompt.
Open the Insurance Table
Select table #3 from the list and press Enter.
Find and Open the Correct Plan
Page down or use jump function to find the specific plan or plans matching your contract. Enter the number of the first plan and press Enter.
Enter the Contract Schedule Name in the Allowable Schedule Field
Press Page Down or [F1 -- Save]
If you are adding the contract to a list of insurance plans, you can press Page Down to go to the next plan and continue assigning the contract schedule. Press [F1 -- Save and Quit] to save your changes and return to the list of plans.
4. Post Insurance Payments and Compare them to Allowed Amounts
Once you have created a Contract Fee Schedule, added allowable amounts, and assigned the schedule to insurance plans, you can post payments in pip and compare them with to the allowed amounts. Follow this procedure:
Run the Post Insurance Payments (pip) Program
You can run pip from the Insurance Billing window or by typing pip at a command prompt.
Select Patient and Charges Using pip's Built-in Tools
For more information on using pip, visit learn.pcc.com or contact PCC support.
Review Contractual Amounts While Entering Payment
On the payment screen, the Allowed column will show the allowable amount. Review the allowed amount as you enter the amount remitted. The amounts should match.
Manage Problems
If the insurance payment does not match the allowed amount, you may do several different things:
Double-check the amounts.
Press [F8 -- Config Allow] to jump into allowedit for the chosen contract schedule and procedure code.
Or, press F12 and use the function keys in pip to research the claim and re-bill if necessary.
Or, review your contracts and contact your insurance carrier liaison.