1. Axiom
  2. AxiomEHR
  3. Billing & Revenue Cycle

RCM - Fee Schedule (Service Code Setup)

Updated

Introduction

 

This article walks you through the Fee Schedule page in the Revenue Cycle Management (RCM) module. The Fee Schedule is where you define the rates for services and procedures, helping streamline billing and claim submission by automatically applying the correct charge amounts. This self-service tool allows you to easily create and maintain your service rates.

 

 

Prerequisites

 

At a minimum, the following page permission(s) enabled under Security Settings for your role or user account:

 

  • Revenue Cycle Management - Fee Scehedule

 

 

Screen Overview - Fee Schedule

 

Below is an overview of the Fee Schedule Page and its main data elements:

 

Screenshot highlights the location of items 1- 3 covered below.
Above screenshot highlights the location of items 1- 3 covered below. View full-size image.

 

  1. Services Table - Displays a list of all services added to your fee schedule. Use the search or download feature to streamline your workflow. If you need to edit multiple entries at once, downloading the data is recommended. You can make changes in Excel and then re-upload the updated file using the Reporting Upload tool.
  2. Service Matrix By Payor Table - Displays the billing matrix for a selected Payor. Use the search or download feature to quickly find or export the information you need.
  3. Action Column - Provides options to:
    • EDIT - Allows you to edit details for a service code.
    • POS - Opens the Place of Service setup, where you can identify rates by payer and place of service. Some payers may have different rates depending on the POS.
    • Qualifications - Indicates whether a specific provider type or qualification is required to bill the service code.  It allows the you to add, review, edit, and delete Qualification relationships for a specific service code. 
    • Cross reference Service - Allows you to track non clinical services such as activities performed within a service (for example, service bundling).
    • NDC Codes - Must be completed if NDC was selected as the payer classification

 

Using the Action Column

 

Most options in the Action column follow a similar workflow:

 

  1. Click the desired action (e.g., Pend, Write-off, Internal Denial, etc.).

  2. A dialog box opens at the bottom of the page with fields relevant to that action.

  3. Select required options (e.g., reason codes, adjustment amounts).

  4. (Optional) Add comments if needed.

  5. Click Submit, Save, or Confirm to apply the action.

     

For example, selecting Pend opens a dialog box at the bottom of the page where you choose a pend reason and optionally enter a comment before submitting. Other actions follow a similar process.

 

 

Screen Overview - New Service Screen

 

Below is an explanation of the fields available in the Add New Service view:

 

Screenshot highlights the location of items 1- 27 covered below
Above screenshot highlights the location of items 1- 27 covered below. View full-size image.

 

  1. Service Code - Enter your CPT or HCPCS code.
  2. Service Name - Enter the name of the service.
  3. COS - Enter the type of service the code is grouped under.
  4. Service Category: Service Subcategory - Select a category (and subcategory, if applicable) for reporting purposes.
  5. Start date - Enter the date the service code becomes available.
  6. End date - Enter the date the service code will no longer be active. If you expect payer rate changes, we recommend using the end of the fiscal year as the end date. The system will automatically create a new fee schedule for the service for the following year.
  7. Maximum Units - Enter the maximum number of units that can be billed per day for this code
  8. Day Limit - Enter a daily limit for the service code. This is often used for per diem codes (e.g., residential services).
  9. Unit Time - Enter the amount of time each unit represents (e.g., 1 unit = 15 minutes).
  10. Min Time Per Occurrence - Enter if there's minimum time that service must use.
  11. State Reporting - Select State Reporting requirement.
  12. Short Description - Enter a shorter version of the service name. This is what providers will see when adding services.
  13. Provider type - Select which type of provider can bill for the service code.,
  14. Face to Face - Check for face to face services.
  15. Global Overlap -  Check to allow a service to overlap other service codes occurring at the same date at an overlapping time in the Progress Note if another code has already been entered for the same Client/Patient. 
  16. Non XIX SMI - Check to allow a service for Non-XIX SMI client in cases where Progress Note business logic disallows codes based on title/SMI status of the Client/Patient. 
  17. Require POS Time - Check to require POS time entry.
  18. Allow Amount Override - TBD
  19. Medicare Reimbursable - Check to send the service to Medicare without issues.
  20. RBHA/Funding Source Reportable - Check to Indicate to the Axiom Billing System that the service is ‘billable’ by default to all Payors. Can be overridden at the Service POS level. 
  21. Non XIX SAPT - Check to allow a service for Non-XIX SAPT clients in case any Progress Note business logic disallows codes based on title/SAPT status of the Client/Patient. 
  22. Allow Save on Closed Patients - Check to allow service edits for closed patients. (Highly recommended to enable.)
  23. Show Transportation Fields -  Check to display transportation related fields.
  24. Prior Authorization Requirements - Check if Payor requires prior authorization.
  25. Telemedicine - Check if this is a telehealth service.
  26. Multi-Day * - Check if service is allowed to span multiple dates of service in a single line-item entry in the Progress Note. . Requires a support ticket to enable.
  27. Crisis Service - Check if a modifier is required by payor.

 

Please Note:

Some modifiers are embedded into service codes, while dynamic modifiers may vary by program. Our team can work with you to set up dynamic modifiers to reduce the need for creating multiple services.

 

 

Screen Overview - Place of Service Screen

 

Below is an explanation of the fields available in the add Place of service view when selected through the Action column:

 

Screenshot highlights the location of items 1- 11 covered below.
Above screenshot highlights the location of items 1- 11 covered below. View full-size image.

 

  1. POS - Select a Place of Service.
  2. Funding category - Select a payer associated with the Place of Service.
  3. Start Date - Enter the date when the place of service becomes available.
  4. End Date - Enter the date when the place of service will no longer be active.
  5. UC Rate - Enter the usual and customary rate for providing the service (for example, what you believe the service is worth).
  6. Contract rate - Enter the expected reimbursement rate based on your contract.
  7. Day limit - Enter the daily limit for the service.
  8. Always bill the Facility as the Renderer - Check to bill under the facility NPI.
  9. Not reportable to this Payor (override top level reportable status) - Check to exclude reporting for this payor (use for payor of last resort).
  10. Override reportable status (used for tiered billing scenarios) - Check to override the top-level reportable status (use for payor of last resort).
  11. Remember what I typed - Check to carry over previous data when updating a Place of Service.

 

 

Instructions

 

Review the below instructions to learn how to:

 

  • Add a Service Code
  • Edit a Service code
  • Add Qualifications
  • Add Cross References
  • Add Service Bundling
  • Add NDC Codes

 

 

Related to:

Was this article helpful?
0 out of 0 found this helpful