Updating Payor Fees
Once you have updated your Service list with all required changes and fees, you should confirm whether these new codes require fees to be entered in any of your Payor fee schedules.
The majority of practices will have Payor files for Payors such as DVA and hospital voucher schemes, and many more will also have health fund Payor files if they are a preferred provider.
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 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’.
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