Fee Schedules

Fee Schedule Types

There are four different types of fee schedules that are used throughout Practice-Web: Normal, Copay, Out of Network, and Fixed Benefit. It's important to familiarize yourself with them before creating, editing, or using fee schedules.

Normal Fee Schedule Types

If you’re contracted with PPO plans (in-network), you’ll select “Normal” when creating new a Fee Schedule for these plans.

CoPay Fee Schedule Types

A CoPay Fee Schedule is used when the patient is responsible for paying a certain dollar amount for each procedure. This would be the case with HMO plans, in which the patient usually pays a reduced fee for services, but you might also see it alongside some percentage plans too. It’s also worth noting that, if a plan has a co-pay charged for the visit, rather than for each procedure, or in addition to procedures, you’ll want to set up a new non-D procedure code to account for the charge and add the procedure code to each appointment.

A blank entry in Copay Fee Schedules may be treated as the patient co-pay being $0 or the patient having a 100% co-pay depending on your Family Module Preferences. To check or change your settings, go to “Setup” in the main menu, select “Family/ Insurance,” and then “Family Preferences.”

Out of Network Fee Schedule Types

It’s helpful to input allowed amounts of plans you’re not contracted with to ensure you’re providing patients with more accurate estimates. Although the difference won’t show as a write-off, the system will recognize the insurance company is only going to pay a percentage of the amount you’ve entered for any given procedure. For this reason, you’ll only want to enter a zero for any given procedure if you know the carrier is not going to pay anything at all. Otherwise, leave it blank and the system will use the provider’s fees.

FixedBenefit Fee Schedule Types

If you’re contracted with an insurance company and the PPO plan pays a set amount for each procedure rather than a percentage, you’ll use the FixedBenefit Fee Schedule Type. A blank entry may be treated as the patient portion being $0 or the patient being responsible for the full PPO contracted amount depending on your Family Module Preferences.

Add Fee Schedule / Create a New Fee Schedule

Fee schedules are found in the Procedure Code List. To access it, click "Lists" in the main menu and choose "Procedure Codes." The following dialog will open.

Next, click the "Fee Scheds" button in the bottom right. The following dialog will open.

Click on the "Add" button.  The "Edit Fee Schedule" dialog will open. 

In the Description box, enter the name of the new fee schedule and select the type of the fee schedule.  Click on the "Ok" button when finished. 

Edit Fees in Fee Schedules

There are two primary ways to edit the fees in fee schedules.

1. Edit fees related to a single procedure code in several or all fee schedules at once.
   
2. Edit some or all fees for some or all procedure codes in a single fee schedule. 

Enter Fees for All Fee Schedules by Procedure Code

In the "Procedure Codes - Fee Schedules" window (accessed by clicking "Lists" in the main menu, then choosing "Procedures"), double-click the procedure code you'd like to change fees for. The following dialog will open.

Choose the fee schedule you'd like to change the fee on in the "Default Fees" box. Then, enter the fee for the procedure for the selected fee schedule.  When finished, click on the "OK" button. Repeat the process for each fee schedule you want to change the fee for the procedure on. 

Edit/Change Fees for Single Fee Schedule

From within the "Procedure" list dialog, highlight the fee schedule (upper right) that is going to be used. 

Locate the desired code, double-click on the fee field, and enter the new fee. Repeat the process for each fee you want to change on the fee schedule. Click the "Close" button when done.

Hide Unused Fee Schedule

From the Lists menu in the main toolbar, click on “Procedure Codes.” Then, press the "Fee Scheds" button in the lower right corner. The Fee Schedules dialog will open.

Click on the “Hide Unused” button on the lower right. Before the tool runs, it will prompt you to make a backup of the database. This may take a while.

Click Ok. Any fee schedules not used by insurance plans, patients, providers, or discount plans will be hidden.

Import/Export Procedure Codes

In the lower-left of the Procedure Code dialog, there are Procedure Code tools.

1. The procedure codes can be exported to XML formatted file and can be imported.  
2. The procedure tools refer to the following choices. Use caution if you do not understand what you are doing you can make changes that cannot be reversed. 

The procedure codes can be exported to XML formatted file and can be imported. The procedure tools refer to the following choices.

Fee Schedule Tools

Fee schedules can be cleared, copied, or increased by percentage. From within the "Procedure" list (List Menu->Edit Codes), click on “Fee Tools" button.  The Fee Schedule Tools dialog opens.

In this dialog, a fee schedule can be cleared, copied, increased/decreased by a percentage. Export or import fee schedules from text files. Global update of all treatment plans is available for a selected fee schedule. Insurance plans fee schedules can be verified here (be certain before using it).

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