Fee Tables are used to produce a Net Accounts Receivable, and generate an automatic contractual allowance for services billed. This is accomplished by entering the Net rates into the Fee Table interface. At the time of billing a claim, the program will automatically create the contractual adjustment based on the way the Fee Tables are set up. 

For more information see articles: [Enter Rates]   [Copy and Paste Fee Table]

The Fee Table program is located in the Payor Master file found under OPTIONS>PAYORS.

Select the payor by name or number, or add a new payor. Instructions for modifying or adding a new payor/insurance company are found in Chapter II.A.

Select the payor by name or number, or add a new payor. Instructions for modifying or adding a new payor/insurance company are found in Chapter II.A.

Once in the insurance screen, select the Fee Maintenance button, also referred to as FEE TABLES in this documentation.

Once in the FEE TABLE menu, the user will need to make some decisions. This document will assist with these decisions.

SET UP

EFF DATE- The cursor defaults to the EFF DATE. The user can choose to enter the effective date of the contract with this payor, or if left blank, this will become the BASE rate. The BASE rate will create a contractual adjustment regardless of the date of service. When an effective date is entered, the contractual adjustment will take place on any charges with a date of service of this date and after. New sites usually start with a BASE rate and add the Eff Date once contract rates change.

Normally, contractual adjustments happen at the time of the FIRST billing. Once an account is billed, a second contractual will not take place UNLESS, the primary payor was self pay. Then if the claim is advanced to an insurance payor as primary, a contractual adjustment will take place.

SERV#- The service number is the charge number which comes from the SERVICE MASTER. There is a look up feature for the SERV# by selecting the F3 button on the keyboard.

RATE- the RATE is the contracted amount the facility/clinic will get paid for the designated service. For example, the gross Room & Board rate may be $1000.00 per day, but the contracted rate may be $400.00 per day. The $400.00 rate would be entered into the RATE field. When the claim is billed, a contractual adjustment will automatically post in the amount of $600.00 per day. This example is dependent on the FOR set up field described below.

FACTOR- the FACTOR works similarly to the RATE, the contractual adjustment will be figured based on a FACTOR, (percentage). For example, if the Room & Board gross rate is $1500.00 per day and the contract rate is 45%, the user would enter .45 in the FACTOR field. When the claim is billed, a contractual adjustment of $825.00 will automatically post leaving a net daily balance of $675.00/day on the A/R.
FOR- the FOR field allows the user to enter a code, which controls how a contractual adjustment is applied.

TAB

A=All Inclusive, takes all the charges on a given day and posts a contractual adjustment so the net of that day is equal to the rate entered. This option is normally used for facilities with a Per Diem Daily rate.

Example: Charges posted on an account includes a Room & Board charge of $1000.00, a Lab charge for $25.00, an H&P (a Professional charge) of $50.00 totaling $1075.00 for this one day. If the Net Rate entered on this payor is $750.00, at the time of billing, a contractual adjustment of $325.00 will post. The charges for each day could be different, but for each day, the net rate will be $750, excluding the discharge day, which will contractualize down to zero.

N=All but Doc (professional charges), contractualizes just like the All Inclusive with the exception of the Doctor charges (professional charges).

Example: using the same example as above, the All but Doc will contractual the same way, but will ignore any profession charge. In the case above, the H&P charge will not be included in the daily contractual adjustment. The contractual adjustment for this one-day would be $275.00.

D=Daily Fee. The Daily Fee also works similar to examples above, only the Room & Board is the only charge contractualized. All other charges are ignored.

Example: Using the example above, the contractual adjustment will only adjust the $1000.00 Room & Board charge, making the contractual for this one day, $250.00.

M=Monthly. The Monthly option is used for contracts where the negotiated rate is a flat rate per month. When this option is used, all the charges, regardless of what they are, would net down to this monthly rate.

Example: Charges are posted for a month of Room & Board, ancillary charges as well as pro fees. The total charges for the month are $12,579.00. The Monthly Rate entered into the Fee Table is $10,000.00. The C/A adjustment would be $2579.00.

B=Billed. The Billed option also ties into the Billing Profiles. If the payor has a billing rule in the profile to override the units at billing, the Billed option will look at the unit(s) at billing and net accordingly. User will also use the B for netting non-room & board (Out Patient Rev Codes) services to $0.00.

G=Gross. The user will never use this option. The program will post a Gross amount to back fill dates where a BASE was never created to 100 percent. For example, if the user enters an effective date of 1/1/11 and the service isn’t included in the BASE schedule, the program will create a BASE record of Gross so a contractual adjustment will not be created on dates of service prior to 1/1/11.