The 'Fee Schedules' option enables the Practices to provide differential charges to Procedures and Products. The created Fee Schedules will be available for selection while generating Invoices and creating Chart Notes. The charges for Procedure codes and Products will be taken from the selected Fee schedules.
To enable the Fee Schedules, follow the steps given below.
Practices can create a Fee Schedule and associate it with Providers, Patients, or Payers. This Fee Schedule will be automatically chosen while generating the Encounter or Invoice.
To create a Fee Schedule, follow the steps given below.
Associating Providers
Practices can associate Fee Schedules with the Providers.
Associating Patients
Practices can associate Patients with the Fee Schedule using the Patient Category.
Associating Payers
Practices can associate Fee Schedules with Payers based on the Payer Name or Payer ID.
Note: Payer-specific Fee Schedule will get changed based on the Patient Insurance selected in the Invoice.
Practices can add Products to the Fee Schedule with differential Charges and Discounts.
For Practices using a common Inventory across all facilities, they can customize the Product Charges or Discounts as shown in the screenshot below.
For Practices using multi-store Inventory, they can customize the Product pricing for each store as shown below.
Practices who have enabled the 'Multi-store settings' can copy the Products from one store to another using the 'Copy from other store' option.
To use this option, the 'Product Name' must be identical in both stores.
Practices can configure alternate CPT codes for specific Procedures based on the Payer-specific requirements.
Example:
According to CMS guidelines, when submitting Claims for E/M Codes such as 99205 or 99215, and the time threshold exceeds, Practices can bill CPT Code 99417 for commercial Payers. However, Medicare does not accept the CPT 99417. CPT G2212 should be used in place of 99417 as per Medicare guidelines.
Practices can create a Fee Schedule specific to Medicare and give an alternate Procedure Code as G2212 for the CPT 99417 to automatically add the necessary CPT in the Invoice or Claim for Medicare.
When generating Invoices or Claims, Charm will automatically apply CPT Code 99215 for commercial Payers based on the default Fee Schedule, and CPT Code G2212 for Medicare Payers based on the Medicare-specific Fee Schedule. This setup ensures compliance with Payer-specific billing guidelines and enhances billing accuracy.
Claims Generated with Alternate Procedure Code
Practices can add Modifiers to Procedure Codes based on the Payer requirements.
For instance, Lab Procedure Codes such as 87880, 87899, and 87905, which qualify as CLIA Waived Tests, do not require any modifiers when submitted to commercial Payers. However, Medicare guidelines mandate the inclusion of Modifier QW when submitting these CPT Codes.
To implement this customization, Practices can create a Fee Schedule specific to Medicare and add Modifier QW with these Lab procedure Tests. When Invoices or Claims are generated, Charm will automatically apply the Modifier QW for the Payer Medicare, ensuring compliance with Medicare billing guidelines and enhancing billing accuracy.
Practices can set a uniform charge or discount to all Procedures using the 'Autofill Procedure Charge or Discount%' option.
During Electronic Claim submission, some Payers may require certain Procedure Codes to have a $0.00 charge if they do not support those codes. Practices can use this option to set all Procedure Code charges with $0.00 and adjust only those that require a different charge.
Choose the 'Charge' or 'Discount' option from the drop-down, enter the value, and press 'Enter'. This value will get populated across all CPTs.
To edit a Fee Schedule, follow the steps given below.
Note: You cannot edit the 'Master Fee Schedule'.
To delete a Fee Schedule, follow the steps given below.
Note: Deleting a Fee Schedule will not impact the existing Invoices or Encounters. Practices cannot delete the 'Master Fee Schedule'.
On automatically choosing the Fee Schedule for an Encounter or Invoice, if there is more than one Fee Schedule available for Providers, Patients, or Payers, the Practices can set the highest priority by reordering the fee schedules.
Example:
Consider a Practice with the following Fee Schedules.
When generating an Invoice, the system automatically selects and populates the Fee Schedule with the highest priority.
Practices have the option to duplicate the existing Fee Schedule.
This helps Practices create different Fee Schedules for different needs with minimal changes to the Charges or Discounts.
For instance, a Practice may need to create a Fee Schedule for Payer A. This Fee Schedule should be similar to an existing one created for a different Payer. In this case, the Practice can duplicate the existing Fee Schedule, rename it, and modify only the necessary CPT codes.
To duplicate an existing Fee Schedule, follow the steps given below.
CharmHealth supports Role-based Access Control (RBAC) using which you can control the access privileges of your Practice members. While creating an Encounter and generating an Invoice, the 'Fee Schedule' option will be available only for the members with the role privilege. The Practice Admin can configure the role-based Fee Schedule access to the Practice members by following the steps below.
In Encounter:
In Invoice:
