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You should only complete this task once you have added, removed, and updated, all required item codes in your EXACT database. |
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The way you update your prices depends on how the Payor has been set up. |
Scenario A: The Payor uses the ‘Combination Rule’
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For new codes that do not have a price dictated by the Payor, just leave the fees alone, and ensure they have been given a price under your default prices in the Service list. (Configure > Services) This is because the Combination rule (used for newer practices) only requires you to actually update the Payor’s fees, leaving the other fees to automatically reference the Service list.
For new codes the Payor is dictating a price for, double click the code and update the price in the Fee field only.
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Scenario B: The Payor uses the ‘This Payor sets both service fees and payor’s portion' rule
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Once you double click on the item code, update the price. To ensure the fees will work correctly, it is important you update them with the same approach used for other item codes in the fee schedule. If you are unsure, double click a code that already has a price, and take note of how it has been set.
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Payor Amount is only relevant for government Payors that cover the treatment cost, such as DVA. 💲 If there is a price in the Fee field only, then the patient owes the full amount. This is common for health fund Payors, as the patient is paying, but the health fund is dictating what some of those fees are. 🆓 If the Fee and Payor amount match, the patient will owe nothing. This is common for payors like DVA and CDBS. (Medicare has not updated its code list yet) 🤲 If there is a difference between Fee and Payor amount, that difference will be the amount the patient has to pay, and will be reflected in their account balance. This is less common, but happens when the Payor arrangement includes a patient ‘co-pay’. |
