As an actuary, you can create a library of fee schedule information based on the
comprehensive list published by CMS (Centers for Medicare and Medicaid Services). Your contracting
specialist can then use this fee schedule information as a base to define the payment terms for
contracts of Fee-for-Service payment type.
Required Editions
A fee schedule library provides information on the standard fees for different time periods.
To create a well-defined library, you need:
- Fee schedule definition records that indicate the effective time period.
- Care fee schedule item records that specify the fees for each procedure code. These records
are always created within the context of a fee schedule definition and multiple records can be
associated with a fee schedule definition.
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Available in: Lightning Experience
Available in: Enterprise and Unlimited Editions with Health
Cloud
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| User Permissions Needed |
| To add fee schedule information |
Create, Read, Update, and Delete access on Fee Schedule Definition and Care Fee
Schedule Items objects |
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From the App Launcher, find and select Fee Schedule
Definitions.
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Click New and enter the name, effective start and end date, and
description of the fee schedule definition. Then save your changes.
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Click the Related tab, then click New in the
Care Fee Schedule Items related list.
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Provide the facility and non-facility price for a selected procedure and save your changes.
Specify the price based on the data published by CMS.
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Add more care fee schedule item records for all the required procedure codes and save your
changes.
We now have the fee schedule information all set for the selected time period. Your
contracting specialist can now select this fee schedule definition when creating a contract
payment agreement of Standard Care Fee Agreement type. And, the payment terms defined in the
selected fee schedule definition are applied for the contract.
