OnSTAFF 2000
You may set up global, professional, and technical charge amounts only, or, you may set up additional software requirements to benefit from features of On-Staff’s charge and payment screens. This page denotes the areas and fields of On-Staff which need to be set up for each of those options. The following pages contain specific software requirements for those areas and fields.
Complete the following software requirements to set up global, professional, and technical charge amounts only:
/Utility/Procedure <Charge Global> and <Professional>
/Utility/Procedure/Modifier <Charge (G/P/T)>
And when using a fee schedule:
/Utility/Procedure/Fee Schedule <Charge>, <Alternate>, and <Prof.>
/Utility/Insurance/Pay Plan/Pay Plan <Insurance Code>
/New Patient Insurance <Pay Plan>
In addition to setting up global, professional, and technical charge amount, complete the following software requirements to benefit from features which affect the /Charges/Charge screen <Patient> box, /Payment/Open_Item <Approved> column, and automatic calculation of payment/adjustment posting by pressing A from the /Payment/Open Item C (command) column:
/Utility/Procedure <Charge Global> and <Professional>
/Utility/Procedure/Modifier <Charge (G/P/T)>
When using a fee schedule:
/Utility/Procedure/Fee Schedule <Charge>, <Alternate> and it’s <Approved>, as well as <Prof.> and it’s <Approved>
/Utility/Insurance/Pay Plan/Pay Plan per contractual agreement
/New Patient Insurance <Pay Plan>
When using unit values and conversion rates:
/Utility/Procedure Charge Global’s <Unit Value> as well as Professional’s <Unit Value>
/Utility/Insurance/Pay Plan/Pay Plan per contractual agreement
/New Patient Insurance <Pay Plan>
For assistance, please contact your Trainer or a Software Support Representative.
/Utility/Procedure Software Requirements
Charge Global: Enter your fee for this procedure code.
Professional: Enter the professional portion of the charge.
Unit Value: (Located to the right of Professional). Enter the unit value corresponding to the professional portion of the charge.
NOTES:
1: When using a modifier whose /Utility/Procedure/Modifier <Charge (G/P/T)> field entry is set to P, the Professional and it’s Unit Value field entry will apply.
2: You now have the ability of having more than one unit value per panel code. See the /Procedure/Unit Value section of your Session II training documentation.
3: The technical portion of the charge will be the difference between the Charge Global field entry and the Professional field entry.
4: The technical unit value will be the difference between the global charge Unit Value and the professional Unit Value.
5: When using a modifier whose /Utility/Procedure/Modifier <Charge (G/P/T)> field entry is set to T, the technical portion of the charge and it’s unit value will apply.
/Utility/Procedure/Modifier Software Requirements
Charge (G/P/T): This field is used to determine which charge to post. Press the [F2] search key to display the following valid choices:
G - Global Charge
Post the global charge:
1. entered in the /Utility/Procedure <Charge Global> field.
1. entered in the /Utility/Procedure/Fee Schedule <Alternate> field when a fee schedule applies.
P - Professional Component Charge
Post the professional charge:
1. entered in the /Utility/Procedure <Professional> field.
1. entered in /Utility/Procedure/Fee Schedule <Prof.> field when a fee schedule applies
T - Technical Component Charge
Post the technical charge:
1. which is the difference between the /Utility/Procedure <Charge Global> field entry and Professional field entry.
1. which is the difference between the /Utility/Procedure/Fee Schedule <Alternate> column entry and the Prof. column entry when a fee schedule applies.
(blank) - If this field is left blank, the default value will be G.
/Utility/Insurance/Pay Plan/Pay Plan Software Requirements
NOTE: The Conversion 0 through Conversion 4 fields are completed ONLY when setting up pay plans for conversion rate/unit value based contractual agreements and otherwise will be left blank.
Conversion 0
through
Conversion 4: To allow for flexibility in setting up conversion rates, these field names have been changed as follows:
From To
Conversion (Surgery) Conversion 0
Medical Conversion 1
Anesthesiology Conversion 2
Radiology Conversion 3
Pathology Conversion 4
Enter the contractual conversion rates in their respective fields. As a suggestion:
Conversion 0 may be used for surgery
Conversion 1 may be used for medical
Conversion 2 may be used for anesthesiology
Conversion 3 may be used for radiology
Conversion 4 may be used for pathology
The /Utility/Procedure <Conversion> field entry will specify which /Pay Plan <Conversion 0 (or 1, 2, 3, 4)> field to use when posting that procedure. See FIG. 1.
NOTE: The following Percent fields are completed when setting up pay plans for conversion rate/unit value or fee schedule contractual agreements.
Percent fields: Enter a contractual percent (i.e., 80 for 80 percent) which is the percentage of the approved amount the insurance will pay.
Each Percent field is associated with the Conversion 0 (or 1,2,3,4) field to the left of the Percent field. The /Utility/Procedure <Conversion> field entry will specify which /Pay Plan <Percent> field to use with the procedure. See FIG. 1.
FIG. 1:
/Utility/Procedure:
Days & Units : Assignment(Y/N) : Conversion : 1 ç
/Utility/Insurance/Pay Plan/Pay Plan:
Conversion 0 : 5.62 Percent: 100.00
Conversion 1 : 5.62 Percent: 80.00 ç
Conversion 2 : 5.62 Percent: 80.00
Conversion 3 : 5.62 Percent: 80.00
Conversion 4 : 5.62 Percent: 100.00
á*
á* The percent column is completed in order to benefit from features of On-Staff’s charge and payment screens. A combination of conversion rate/unit value and fee schedule fields is possible. Contact your Trainer or a Software Support Representative with questions.
NOTE: The Scale Code field is completed ONLY when setting up a pay plan for a conversion rate/unit value based contractual agreement and otherwise will be left blank. This field allows for different unit value scaling systems between contracts.
Scale Code: Enter the user defined code for the scaling system (i.e., set of unit values) used by this insurance contract.
This field is used to determine which scaling system (/Utility/Procedure/Unit Value <Scale Code>) to use to get the unit values. If this field is blank, the /Utility/Procedure <Unit
Value>field entry will be used. The following are a few known scales, others may apply to your practice:
McGraw Hill
RBRVS
CRVS
NOTE: The Unit Value Pointer field must be entered when the Scale Code field is entered.
Unit Value Pointer: Enter which unit value (1, 2, 3) is to be used.
This field is used to determine which unit value in the scaling system (indicated in the above entered Scale Code field) to use. The /Utility/Procedure/Modifier <Charge (G/P/T)> field entry will specify which column to use, Global, or Prof.. The difference between the Global column entry and the Prof. column entry will be the technical unit value. See FIG. 2.
FIG. 2:
Utility/Procedure/Unit Value:
|
Scale Code : MH Name: McGraw Hill |
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C |
Panel |
Global 1 |
Prof. 1 |
Global 2 |
Prof. 2 |
Global 3 |
Prof. 3 |
|
|
99213 ...etc.
|
5.2 |
5.46 |
|
|
|
|
|
MODIFY UNIT VALUE |
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NOTE: The Insurance Code field MUST BE ENTERED WHEN A FEE SCHEDULE IS USED.
Insurance Code: Enter the /Utility/Insurance <Insurance Co. Code> field entry which indicates the entries within the fee schedule to use.
This field is used to determine which entries to use within the fee schedule specified in the Provider Code field below.
This field allows you to share, for example, the Medicare entry within a fee schedule with another insurance.
Normally, the Insurance Code field would be left blank for contracts based on a conversion rate/unit value contractual agreement. The exception would be when a specific procedure is negotiated as fee for service. When this happens, set up a fee schedule for the appropriate provider containing the insurance and fee for service charge(s). Enter the Insurance Co. Code field entry for the insurance company in this field. This indicates that, for a pay plan based on a conversion rate/unit value agreement, the fee schedule of the provider indicated in the Provider Code field below contains fee for service charge(s). Be sure to appropriately flag the /Utility/Procedure <HMO Adjust> field and/or use the pay plan Carve Out field above.
NOTE: The Provider Code field would contain an entry when sharing another provider’s fee schedule. Leaving this field blank indicates to On-Staff to use the fee schedule of the provider to which charges are posted and for the above noted Insurance Code field entry(ies) within the fee schedule.
Provider Code: Enter the /Utility/Procedure/Fee Schedule <Provider Code> field entry for the provider whose fee schedule is to be used. If this field is left blank, the fee schedule of the provider to which charges are posted will be used.
NOTE: The /Utility/Provider <Fee Schedule Provider> field has been removed. Sharing a fee schedule is now set by the entry made in this field.
The Provider Code field would normally be left blank for conversion rate/unit value contractual agreements. The exception would be when a specific procedure is negotiated as fee for service. See the Insurance Code field above.
/Utility/Procedure/Fee Schedule Requirements
When a fee schedule is used, follow instructions for /Utility/Procedure/Fee Scheduleset up of global, professional, and technical charges and/or their alternate charge amounts found in your Session II training documentation.
Main Menu/New Patient Software Requirements
The pay plan code in the New Patient Insurance screen Pay Plan field must specify a pay plan defined in /Utility/Insurance/Pay Plan/Pay Plan, i.e., the New Patient Insurance screen Pay Plan field entry matches a /Utility/Insurance/Pay Plan/Pay Plan <Plan Code> field entry.
Following is a quick determination of whether the patient’s pay plan is set up based on a fee schedule or conversion rate/unit value contractual agreement:
If the patient’s pay plan has Insurance Code and Percent field entries, the pay plan is based on a contractual fee schedule set up.
If the patient’s pay plan has Conversion 0, (or 1, 2, 3, 4) and Percent field entries, the pay plan is based on a contractual conversion rate/unit value set up.
POSTING THE CHARGE(S)
Post charge(s) as usual. The global, professional, or technical charge amount will be posted only when all software requirements are in place at the time of posting the charge. The charge amount to be posted is determined as follows:
1. Post the charge from the fee schedule.
When a modifier is used, post the charge based on the /Utility/Procedure/Modifier <Charge (G/P/T)> field entry. When this field is left blank (blank defaults to G) or a modifier is not used, the /Utility/Procedure/Fee Schedule <Alternate> column entry will be used.
1. Post the charge from the procedure, i.e., either there is no fee schedule (the /New Patient Insurance screen Pay Plan field is blank) or the fee schedule does not contain this panel/procedure.
When a modifier is used, post the charge based on the /Utility/Procedure/Modifier <Charge (G/P/T)> field entry. When this field is left blank (blank defaults to G) or a modifier is not used, the /Utility/Procedure <Charge Global> field entry will be used.