Allowable Schedules

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Name — Enter a unique, descriptive name for the allowable schedule.
3. Effective date — Enter or select the date that the schedule takes effect for this payer.
   Note: You must set an effective date or an expiration date unless you select the Evergreen? option.
4. Evergreen? — Click Yes to indicate that the allowable schedule is renewed automatically each year.
5. If Evergreen? is set to Yes, the following required fields appear:
   1. Notice period — (Required) Enter the number of days in advance that you must notify the payer if you plan to terminate your contract. The notice period is as specified in your contract.
   2. Notice period date — (Required) The date by which you must notify the payer that you plan to terminate or request changes to your contract. To calculate this date, athenaOne assumes an anniversary date of one year and subtracts the number of notice period days.
      Note: athenaOne automatically updates this date each year if no changes are made to the allowable schedule following the assumed anniversary date.
6. Expiration date — Enter or select the last day that the schedule is valid for this payer.
   Note: This field is hidden if you set the Evergreen? option to Yes.
7. Allowable category — By default, the allowable schedule applies to all allowable categories, but you can apply the schedule to selected categories.
• Click the Selected global option to select specific global categories.
• Click the Selected local option to select specific local categories.
8. Medical group — To apply the allowable schedule to specific medical groups only, click Selected and then select the medical groups from the list.
9. Department — (athenaEnterprise organizations only). To apply the allowable schedule to specific departments only, click Selected and then select the departments from the list.
10. Provider — To create an allowable schedule based on provider, you have the following options:
• Selected provider(s) by name — Click this option and select the provider names from the list.
• Selected provider(s) by specialty — Click this option and select the specialties from the list.
  Note: Any new providers added within the selected specialties are automatically included in the schedule.
• Selected provider(s) by type — Click this option and select the provider types from the list.
  Note: Any new providers added within the selected types are automatically included in the schedule.
11. Auto write-down contractual amount at charge entry? — This option applies to claims when the allowable amount is less than the charge amount. If you set this option to Yes, athenaOne applies the contractual adjustment — as defined in the allowable schedule at the time of claim creation — to applicable claims. athenaOne voids and replaces the downward adjustment when you receive remittance.
    Note: Using this option together with the Auto write-up contractual amount at charge entry? option increases the accuracy of your A/R reports.
12. Auto write-up contractual amount at charge entry? — This option applies to claims when the allowable amount is greater than the charge amount. If you set this option to Yes, athenaOne applies the contractual adjustment — as defined in the allowable schedule at the time of claim creation — to applicable claims. athenaOne voids and replaces the upward adjustment when you receive remittance.
    Note: Using this option together with the Auto write-down contractual amount at charge entry? option increases the accuracy of your A/R reports.
13. Workers' compensation injury state? — If the allowable schedule applies to workers compensation claims, select the state in which the injury occurred.
14. Notes — Enter any notes about this allowable schedule.
15. Click Save. The system assigns a unique numeric ID to the new schedule. The schedule appears in the list below (but contains no allowable information).

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Click copy for the allowable schedule to copy.
   The allowable schedule fields at the top of the page are pre-populated with the existing allowable schedule's information.
   
3. Name — Enter a new name for the new allowable schedule to avoid conflicts.
4. Effective date — Change the effective date for the new allowable schedule.
5. Expiration date — Change the expiration date for the new allowable schedule.
6. Allowable category — Change the allowable category of the new allowable schedule to avoid conflicts.
   
7. Click Save.
   

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Click update for the current allowable schedule.
3. Expiration date — Change the expiration date to one day before the new allowable schedule's effective date.
4. Click Save.
5. Click copy for the same allowable schedule.
6. Name — Enter a new name for the new allowable schedule.
7. Effective date — Change the effective date to the day following the expiration date of the current allowable schedule, to ensure that the effective dates of the current and new allowable schedules do not overlap.
8. Click Save.

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Locate the schedule in the list below.
3. Click the update link. The effective and expiration dates appear in the fields at the top of the page. Blank implies a date in the indeterminate past or future.
4. Edit the dates and notes fields as needed.
5. Click Save.

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Click the update link next to the schedule's name.
   The Update Allowable Schedule view appears.
3. Click the Add Terms and Conditions link.
   The Allowable Schedule Terms and Conditions page appears.
4. Under the Reimbursement Methods heading, select Based on global allowable schedule.
5. Select the appropriate state allowable schedule from the list.
6. Click Save.

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Locate the schedule that you want to update in the list below.
3. Click the edit procedure fees link. The Procedure Fees page appears.
4. Click Show All.
5. Look at the heading at the top of the page to verify the payer and name for this schedule. (If you are in the wrong schedule, click the Allowable Schedules link on the left side of the page.)
6. Procedure code lookup or Procedure description lookup — Enter the procedure code or exact description then click Filter, or click Show All to display the complete list of procedure codes in the schedule.
7. Click the update link for the desired procedure code. The Edit Procedure Code view appears.
8. Edit the fields as needed.
9. Patient-facing description — You can use this field to create a procedure code description that appears on billing statements. This description overrides the regular procedure code description on billing statements.
10. Procedure code group — You can use this field to assign the procedure code to a procedure code group. This action can be done for the default schedule or for a specific payer.
11. Revenue code — If your practice has the UB-04 billing feature enabled, you can type a period to access the Revenue Code Lookup tool to populate the Revenue code field.
12. Click Save.

1. Display the Allowable Schedules page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Allowable Schedules.
2. Locate the schedule in the list below.
3. Click the delete link. A warning message appears.
4. Click OK to delete the schedule, or Cancel to preserve it.

Note: Deleted schedules appear disabled in the list. To restore a deleted schedule, click the undelete link.

 

 

Before you create an allowable schedule, it may be helpful to first use the Local Allowable Categories page to set up local allowable categories that accurately reflect your payer contracts.

 

The results you obtain from running the Payment Mismatch Tracking report depend on the accuracy of your allowable schedules in athenaOne. athenahealth strongly recommends that you enter your allowable schedules in athenaOne.

 

Using an Excel file that you create, athenahealth can upload the allowable schedule to the new schedule name that you created using the copy link.

 

To enable athenahealth to upload the allowable schedule, please complete the athenaOne Fee and Allowable Import Template (located on the Success Community). After you complete the template, submit an online support case with the template attached (or uploaded via the Practice Files page) by selecting Support > Create Case or Call in the Main Menu.

 

After you complete the Excel file, athenahealth can upload the schedule for you. If there are any errors in the file that you asked athenahealth to upload, you will need to fix them in order for athenahealth to upload the schedule on your behalf.

 

Note: If the Payment Mismatch Tracking report results show charges in the "unknown" columns, those codes are not currently listed in the allowable schedule. If all charges appear as unknown, it is possible that no allowable schedule is configured for this payer, or that the allowable schedule is configured incorrectly.

 

By default, this page displays only active schedules. To show inactive schedules, click Show Inactive Allowable Schedules. To hide inactive schedules, click Hide Inactive Allowable Schedules.

• Active schedules are allowable schedules that are not deleted and not expired.
• Inactive schedules are allowable schedules that are deleted or have expired.

If yours is an athenaEnterprise organization, refer to Department Fee Schedules for additional information. If your practice does not use athenaEnterprise:

• A given payer can have only one fee schedule and one allowable schedule for a given date range.
• A given payer must have one fee schedule and one allowable schedule in effect at all times.

You can update the date range for an entire allowable schedule using this page.

 

To edit individual procedure codes, descriptions, or fees, click the edit procedure fees link next to an allowable schedule.

 

 

It is important to record the expected coinsurance percentage (if there is one). When this is recorded on the Insurance Policy Details page, then the expected coinsurance amount appears on the Claim Review page when a claim is created. The coinsurance amount is marked "unpaid, expected co-insurance, not yet a formal charge."

 

If your practice has the payer's allowable schedule in athenaOne, and the procedure code is included in the allowable schedule, the expected coinsurance amount is 20% of the allowable.

 

If the payer's allowable schedule is not in athenaOne (or if the allowable schedule lacks the procedure code) the expected coinsurance amount is 20% of the charge amount from the fee schedule.

 

 

Schedule names must be unique. When you use the copy link to create a new schedule, you must ensure that the original and newly created schedules do not have overlapping effective and expiration dates. You must first set an expiration date for the original schedule and then select an effective date for the new schedule that is after the expiration date of the original schedule. Schedules with the same allowable category for the same departments must not have overlapping effective and expiration dates.

 

 

Our posting policy follows the Florida MVA 80/20 rule. Florida MVA insurance regulations state that there is an 80/20 split on the state-defined allowable amounts in relation to services rendered for an MVA injury—80% of the allowed amount being paid by the insurance carrier, and the remaining 20% being the responsibility of the patient. Any amount in excess of the state-defined allowable amount will be posted as a contractual adjustment.

 

Note: Only the following states have defined MVA allowable schedules:

• Florida
• New Jersey
• New York
• Oregon
• Pennsylvania

athenaOne has imported state-defined MVA allowable schedules for:

• Florida
• New Jersey
• Oregon

athenaOne has imported state-defined WC allowable schedules for:

• Florida
• Texas