OnSTAFF 2000
Fee Schedule and Pay Plan Set UP
Step One:
Set Up the Utility/Procedure/Fee Schedule
<Insurance> Enter the Utility/Insurance <Insurance Code> of the plan. If there is more than one insurance code that uses the same Fee Schedule, only set up one insurance code. They will be shared using the Pay Plan (Step Two), i.e.: Medicare and Medi-Medi.
<Panel/CPT> If using Panel Codes that are the same as the CPT/Billing Code, Panel-Speed Codes and/or Panel-Exploding Codes which post multiple charges; be sure to enter both/all in the Fee Schedule. See below screens:
<Alt Charge> The Utility/Procedure <Charge Global> fee will default to this field. If billing a fee different from that set up in Utility/Procedure <Charge Global> for this plan enter the new fee here. If billing the same fee press [Enter] to accept the default.
<Approved> When completing, enter the Approved fee in the <Approved> column, NOT the amount you expect to receive. NOTE: If posting payments using Method A, the system will automatically adjust off the difference between what was billed and the approved amount, leaving it as either the secondary insurance or patient responsibility.
<Prof.> and <Approved> (2nd approved column on far, right side of screen) If billing Professional and Technical Component billing review the Utility/Procedure <Professional> field. If completed and the Utility/Procedure/Modifier <Charge> = P or T the Fee Schedule <Prof.> and <Approved> (2nd approved column on far right side of the screen) needs to be completed. If the modifiers for the Professional and Technical fees have the Utility/Procedure/Modifier <Charge> = C; the 2nd <Approved> (column on far right side of Fee Schedule screen) may be left blank.
Step Two:
Set Up the Utility/Insurance/Pay Plan/Pay Plan
Only the fields that apply to the Fee Schedule set up will be explained. For explanations on fields not discussed here refer to the OnStaff documentation.
<Plan Code> Usually this is assigned the same code as the Utility/Category
<Effective Date From> If completed, OnStaff will default this date to the Patient/Insurance <From> date whenever the patient has this Pay Plan.
<Deductible> If completed, OnStaff will default this amount entered here to the Patient/Insurance <Deductible> whenever the patient has this Pay Plan.
<Percent> Enter the percentage of the Fee Schedule <Approved> that the plan is contracted to pay. There are 5 percent fields; all need to be completed. The first is usually used for Surgical procedures, the second is for Medical, the third for Anesthesia, the fourth for Radiology and the fifth for Laboratory. These can be changed if needed to meet client needs.
<Insurance> Enter the Fee Schedule <Insurance> code
<Provider> Enter the Fee Schedule <Provider Code>
Step Three:
Modify the Utility/Procedure <Conversion>
<Conversion> This field defines which type of service this procedure is: Surgery, Medicine, Anesthesia, Radiology or Pathology. The <Conversion> field works in conjunction with the Pay Plan <Percent> fields to determine what percentage of the Fee Schedule <Approved> should be paid by the plan. Press [F2] for the list of options.
Step Four (if needed):
Check the Utility/Procedure/Modifier
If billing for Professional and Technical component billing, the Utility/Procedure/ Modifier should be set up one of the two ways shown above.
If the Professional Fee has been set up in the Utility/Procedure <Professional> field, then the Modifiers should be set up like the above example on the left. The Technical Fee will be calculated by subtracting the Procedure <Professional> fee from the <Charge Global>:
<Multiplier> Not applicable
<INC/DEC (I/D/N)> Not applicable
<Charge (C/P/T/R)> set to P for Professional or T for Technical
If the Professional fee is based on a percentage of the Procedure <Charge Global> complete the Modifier screen like the above example on the right:
<Multiplier> Enter the percentage of the Procedure <Charge Global> that should be subtracted from the <Charge Global> to calculate the remaining percentage that should be billed. Do NOT enter the percentage of the <Charge Global> that you want to bill.
INC/DEC (I/D/N)> set to D. OnStaff will multiply the Procedure <Charge Global> by the Modifier <Multiplier> and subtract that amount from the <Charge Global> fee.
<Charge (C/P/T/R)> set to C – Procedure <Charge Global>
Step Five:
Modify the Utility/Category <Default Plan>
<Default Plan> If completed, when registering a patient with this category the <Default Plan> code will default to the New Patient/Insurance <Pay Plan> field. The same Pay Plan code can be linked to many categories if applicable, i.e.: Medicare, Medi-Medi and Medicare with Secondary Insurance.
Step Six:
Correct existing New Patient <Category> and Insurance <Pay Plan>
New Patient <Category> and Insurance <Pay Plan> If the Utility/Category <Default Plan> is completed and entered in the New Patient <Category> field, the <Default Plan> will default to the Insurance <Pay Plan> screen.
