You should only complete this task once you have added, removed, and updated, all required item codes in your EXACT database.
Overview:
Once you have updated your Service list with all required changes, there will be some new item codes you may need to update prices for in your Payor fee schedules.
This is because pricing updates in the Service list do not necessarily carry over to your Payor fees schedules.
The majority of practices will have Payor files for Payors such as DVA and their respective hospital voucher schemes, and many more will also have health fund Payor files if they are a preferred provider.
Steps:
Go to File > Payors
Use the Search box to select a Payor
Click the ‘list’ icon to the right of the search box to confirm which Payors your practice is using.
Click the Fee Schedule button
Locate the item code and double click on it
The way you update your prices depends on how the Payor has been set up.
Scenario A: The Payor uses the ‘Combination Rule’
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.
Scenario B: The Payor uses the ‘This Payor sets both service fees and payor’s portion' rule
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.
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’.
