Configure Contract Fee Schedules (allowables)

Partner can track contract fee schedules, also known as allowables, in the Contract Fee Schedule Editor (allowedit). You can create and manage multiple contract rates, make changes to expected fees that will occur after a specific date, and assign the completed contract fee schedules to selected insurance plans. 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.

Follow the procedures below to create fee schedules, add allowable amounts, and assign the result to different insurance plans.

Create a New Contract Fee Schedule

Follow the procedure below to create a new contract fee 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 F5Add 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.

Make a Mistake?: Don’t worry if you make a mistake naming your fee schedule. You can press F3Change Name from the main allowedit screen to rename a fee schedule.

Press F1Process 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.

Clone an Existing Contract Fee Schedule

If a lot of allowables for an insurance contract are changing (during an insurance contract renewal, for example), you may wish to clone an existing contract fee schedule and make changes to it, keeping the old fee schedule in place until you make the transition.

Follow the procedure below to clone a set of allowables.

Select Original Schedule

Use the arrow keys to select the original contract fee schedule in allowedit.

Press [F6 – Clone Schedule]

Enter a New Name, Optionally Set Start Date

Enter a name for your schedule and decide whether all procedures should begin with a new “start” date, such as a new contract date, or if dates from the original schedule should be copied.

Press [F1 – Save]

Remember to Assign: Once you have cloned an old schedule, you can begin working on the clone and making changes. Your new schedule will not affect any claim result posting until after you assign it to insurance plans. From the main screen in allowedit, press F4Assign Schedule to begin the process.

Add Contract Fee Amount By Procedure Code

You can add or edit contract fee amounts for a specific procedure code. Follow the procedure below to see an example.

Run the Contract Schedule Editor (allowedit) and Select Your Fee Schedule

You can find the Contract Fee Schedule Editor in the Insurance Configuration window. You can also type allowedit at a command prompt.

Use the arrow keys to select the contract schedule to which you wish to add fees.

Press

F1 – Edit By CPT

Press F1 to edit the schedule.

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

Press F1 to save your changes.

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.

Edit Contract Fee Amounts for All Codes

Follow the procedure below to edit a contract fee schedule and enter fee amounts for all codes based on a percentage of Medicaid’s RBRVU value.

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.

Use the RBRVU and BNA Calculations

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 F3Recalculate RVU.

  • Percentage: If you are creating a contract based on a percentage of Medicare’s reimbursement, edit the percentage column 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.

Assign Contract Fee Schedule to Insurance Plans

After creating a Contract Fee Schedule in allowedit and entering the allowable amounts, you must assign the schedule to specific insurance plans.

Select the Completed Schedule in allowedit

Use the arrow keys to pick the contract fee schedule you wish to assign.

Press [F4 – Assign Schedule]

Review the Existing Assigned Insurance Plans

If the schedule is already assigned to any insurance plans, they will appear on the first Schedule Assignment screen.

Press Page Down and Page Up to review the list.

Press [F4 – Assign]

Select Additional Plans

Use the arrow keys to find plans and press F2Select to choose groups or individual plans.

Filter For Easy Selection: Use F5List by Group and F6List by Pattern to find plans more easily and select them.

Press [F1 – Save]

Press F1 to confirm your selection and return to the contract fee schedule’s list of plans.

Post Payments, Review Values!

Use the manual Post Insurance Payments (pip) program to test your contract fee schedule. Read Post Insurance Payments and Compare to Allowed Amount to learn more.

Working in the Table Editor: When you assign a contract fee schedule to a plan or group of plans, allowedit places the name of the schedule into the insurance plan’s entry in the Table Editor (ted). When your practice clones insurance table entries to create new plans, it is important to note that a new, cloned plan will have the same allowable schedule.

  • Last modified: August 3, 2015