CPT Charges, Fee Schedules & Contracted Rates
For each insurer, you can set fee schedules which define the dollar amount the insurer has agreed to pay a specific doctor for a specific CPT. i.e. the contracted rate fee schedule.
The allowed amount is the insurer’s contracted rate (for the doctor who performs the service). The difference between the contracted rate & your standard CPT fee is automated as a non-collectible payment entry in the ledger.
For example if a charge for a CPT is $75 & the fee schedule allowed amount is $50 when adding visits a $25 non-collectible payment will be posted to ledger automatically along with the visit/charges.
After you setup the allowed amount fee schedules for all codes for an insurer, select the fee schedule to be used for each doctor in your office for this insurer.
Up to three (3) fee schedules can be stored for each CPT. This allows doctors to have different scheduled fees. For example a DC might have one schedule, a therapist another & other doctor or therapist yet another if necessary. For simplicity start with schedule A & leave the others blank if not needed.
It is important to remember that most states legally require you to charge the same amount for services regardless of reimbursement method. So the patient with or without insurance should be charged the same cost for a given CPT/service. You can use ledger entries to “write-off” or “contractual reduced rate” to reconcile the discounted rate given to insurers or patients from this standard service/cpt dollar amount.
.
The “Fee Schedule in ChiroPulse365 totally automates contracted rates since the “non-collectible contracted rate” ledger items are added when posting charges/services. In addition, the patient invoice clearly shows that the services were paid at a discounted rate to allow for better patient relations. For example, a patient would typically be less reluctant to complain about a co-payment or balance due when they see your rates & reimbursement was significantly reduced by their insurer.
