Creating Provider Fee Schedules

It is relatively common in group practices and other organizations for different providers to have different fees for the same service. The fees may vary from provider to provider, or may be keyed to the type of provider, that is there is one fee for psychiatrists, another for psychologists, and yet another for mental health counselors, all of whom may be providing the service coded as “Psychotherapy, 45 minutes”. SOS provides the means to create fee schedules linked to each of a provider’s Billing Profiles, to each Provider Type, and a default fee schedule based only on service. As each new Charge transaction is created, once you specify the Provider Billing Profile and the Service, the system will lookup the appropriate fee as follows:

1. Search for a fee that matches both the Provider Billing Profile and the Service. If one is found, it will be inserted into the transaction as the fee. If not…
2. Search for a fee that matches both the Provider Type and the Service. If one is found, it will be used. If not…
3. Search for a default fee for the selected Service. If one is found, it will be used. If not, the fee will be left blank and you will have to manually enter it.

To create your own Fee Schedules, first you will want to collect the relevant data — that is, who charges what for which service.

Default Fee for Each Service

If a more specific fee schedule is not found, the system will just check for a default fee for the Service being entered in the Daysheet. To specify the default fee for a Service:

1. Expand the Common Lookups section in the Navigation Bar on the left of your screen, then click Services.
2. Locate the Service for which you want to set the default fee.
3. Double click that line in the list to open the Service’s detail view.
4. Enter the desired amount for Default Fee Per Unit.
5. Click the Save or Save & Exit icon.

Provider Type Fees

If your organization has standard fees for a handful of Provider Types, then your job is almost as easy as simply entering the default fee for each Service. Once you have compiled a list of the fees for each of your Provider Types, go to Common Lookups > Provider Types in the Navigation Bar on the left side.

1. Double-click the desired Provider Type if it already appears in the list, or add a new one.
2. The lower portion of the Provider Type form is a list box in which you can insert services with their appropriate fees for this type of provider.
3. Select the desired Service using the drop list for that field.
4. Enter the appropriate amount in Fee Per Unit.
5. If your organization tracks the internal cost of providing units of service, indicate the appropriate amount in the Cost Per Unit field. If not, just leave that field blank.
6. Click the Save or Save & Exit icon.

Provider Billing Profile Fees

If your providers have their own fee (different from both the default fee and the relevant Provider Type fee) for one or more service, then you can create a fee wherever appropriate in one or more of the provider’s Billing Profiles:

1. Navigate to Providers in Common Lookups.
2. Open the Provider for whom you want to enter a fee.
3. Click the Billing Profiles tab.
4. Select the Billing Profile for the fee.
5. Select the Billing Profile Fees tab.
6. Add the Fee entry, specifying the appropriate Service and Fee Per Unit values.
7. Save.
8. Repeat for other services and Billing Profiles as needed.