1. Fee Schedules in Lytec allow you to associate different charge / allowed amount / co-pay / write-off values for different transaction codes and insurance carriers.
2. Fee Schedules are linked to Insurance Companies through a Fee Schedule Type, we will look at each of these elements in a moment.
3. In this example we will create a Fee Schedule for “Medicare”:
4. On the main menu, click Lists, then Standard Lists, then Fee Schedule Types.
5. Enter a Fee Schedule Type Code, such as MCR, MCARE, or MEDICARE.
6. Also enter a Name, like Medicare or Medicare Part B. You do not have to use the values listed here, these are just examples, as long as you know what the codes and names mean.
7. Click Save when Finished.
8. Back at the main menu, click Lists, then Standard Lists, mouse-hover over Fee
Schedules, then click Fee Schedules.
9. Enter a Fee Schedule Code, such as MCR, MCARE, or MEDICARE (you can use
the same codes as the Fee Schedule Type Codes mentioned above, and again these are just examples).
10. Click the magnifying glass icon next to the Type field and select a type.
11. Enter the Year of which this fee schedule is based on or for.
12. Enter the Valid date from and to values (note that the program will not use the fee schedule values if the date of service is out of this range).
13. The Conversion Factor is determined by the insurance carrier. This field indicates how many dollars are equal to one RVU for the year’s fee schedule, as designated by the insurance company. RVU is short for Relative Value Units, a national standard that is based on the resources used in providing a service. If unsure, leave this at $1.0000.
14. Click the Save button on the right-hand side of the window.
15. Next Click on the Fee Schedule tab.
16. Click the Add Default Rows button to pull all the Transaction/Procedure codes that have been entered into this fee schedule. Click Yes when prompted.
17. Once transaction codes appear in the list you can highlight any line and click Edit Row at the bottom of the window.
18. Verify the Transaction Code and CPT Code match.
19. On this window you can lookup and/or enter the Carrier No.and Locality No. (Double check with your payer, as the values below may have changed).
|00510||00||ALABAMA||00903||01||DC + MD/VA SUBURBS|
|00831||01||ALASKA||00590||03||FORT LAUDERDALE, FL|
|00520||13||ARKANSAS||00590||99||REST OF FLORIDA|
|31146||26||ANAHEIM/SANTA ANA, CA||00511||01||ATLANTA, GA|
|31146||18||LOS ANGELES, CA||00511||99||REST OF GEORGIA|
|31140||05||SAN FRANCISCO, CA||00952||16||CHICAGO, IL|
|31140||06||SAN MATEO, CA||00952||12||EAST ST. LOUIS, IL|
|31140||09||SANTA CLARA, CA||00952||15||SUBURBAN CHICAGO, IL|
|31146||17||VENTURA, CA||00952||99||REST OF ILLINOIS|
|31146||99||REST OF CALIFORNIA*||00630||00||INDIANA|
|31140||99||REST OF CALIFORNIA*||00826||00||IOWA|
|00528||01||NEW ORLEANS, LA||00820||01||NORTH DAKOTA|
|00528||99||REST OF LOUISIANA||16360||00||OHIO|
|31142||99||REST OF MAINE||00835||01||PORTLAND, OR|
|00901||01||BALTIMORE/SURR, MD||00835||99||REST OF OREGON|
|00901||99||REST OF MARYLAND||00865||01||METRO PHILADELPHIA, PA|
|31143||01||METROPOLITAN BOSTON||00865||99||REST OF PENNSYLVANIA|
|31143||99||REST OF MASS||00973||20||PUERTO RICO|
|00953||01||DETROIT, MI||00870||01||RHODE ISLAND|
|00953||99||REST OF MICHIGAN||00880||01||SOUTH CAROLINA|
|00740||02||METRO KANSAS CITY, MO||00900||31||AUSTIN, TX|
|00523||01||METRO ST. LOUIS, MO||00900||20||BEAUMONT, TX|
|00740||99||REST OF MISSOURI*||00900||09||BRAZORIA, TX|
|00523||99||REST OF MISSOURI*||00900||11||DALLAS, TX|
|00751||01||MONTANA||00900||28||FORT WORTH, TX|
|31144||40||NEW HAMPSHIRE||00900||99||REST OF TEXAS|
|00805||99||REST OF NEW JERSEY||31145||50||VERMONT|
|00521||05||NEW MEXICO||00973||50||VIRGIN ISLANDS|
|00803||02||NYC SUBS/LONG I., NY||00836||02||SEATTLE (KING), WA|
|00803||03||POUGHKPSIE/N NYC||00836||99||REST OF WASHINGTON|
|14330||04||QUEENS, NY||16510||16||WEST VIRGINIA|
|00801||99||REST OF NEW YORK||00951||00||WISCONSIN|
*Note: It is recommended that a “Default Location” be set in the provider file before creating a fee schedule. If one was not entered you can delete the fee schedule (before it is linked to an insurance carrier) and create a new one. If it is set before this the Carrier Number and Locality numbers will auto-populate.
20. You can also enter Modifier 1, Modifier 2, Modifier 3, and Modifier 4, if you would like a default value to appear when entering Transactions in the Charges and Payments window.
21. Enter Facility Allowed (for services performed at a facility), Non-Facility Allowed (for services performed at a non-facility). The Charge amount should have pulled from the Default field when the transaction code was originally entered, but can be corrected here if its wrong.
22. Enter a Co-Pay amount, percentage of the charge, or percentage of the allowed amount, then make the appropriate Co-Pay Type selection. If you are not sure you can leave these fields as they are.
23. You can enter a Write-Off value, for later use with the Automatic Write function.
24. The Type of Service field is typically not used; however, you can get a list by going into Lytec Help (Help, then Help Topics on the Main Menu) then searching for Type of Service Codes.
25. Next lookup and/or add a Place of Service value (see Step 9 of the Entering Transaction Codes section of this guide for a list of values).
26. Click OK, then Save, when finished.
27. To complete the association (we’ve already linked the fee schedule to the fee schedule type, now we’re going to link the fee schedule type to the insurance company), on the main menu click Lists, then Insurance Companies.
28. Select the insurance carrier (in this example Medicare), and on the Information tab, in the Carrier section, click the magnifying glass, and select the appropriate Fee Schedule Type.
29. Click Save when finished.