Athenahealth Fee Schedule Optimization: Lesson 1
A fee schedule is a table of procedure codes and their corresponding fees charged by a practice under a contract with a particular insurance package or allowable category. You can manually create fee schedules or provide athenahealth a spreadsheet of procedure codes and fees for importing.
For athenaOne practices – we recommend an annual review of your fee schedule to ensure you are not leaving money on the table.
Why should I update my fee schedule annually?
Remove expired CPT codes
Add new CPT codes or update descriptions
Ensure allowed amount is less than charge amount
How do I find out if my fee schedule needs to be optimized?
1. Review https://www.cms.gov/ or https://www.ama-assn.org/ to get the new code changes, then match to your fee schedule.
a. You can also look up codes in Validate Codes on the Claim Edit screen or go to the ‘Claims’ tab on main toolbar>Code and Knowledge Base to search for codes.
2. Run the Payment Mismatch Tracking Report (monthly or quarterly) to show whether your contracted rates match your actual allowed amounts by payers. If you have your allowable schedules (contracted rates) loaded in athenahealth already, this report will show below, at, or above expected amount. If you do not have any contracted rates loaded, you will only see unknown -- which can still be helpful.
a. Go to Reports tab in main toolbar>Payment Mismatch Tracking
i. Pull the report by filling in ‘Start/end date’ by year to date and by payment post-date and keep all other fields unchecked.
ii. Run report as XML.
iii. Click on each hyperlink to open a new tab on the left side of screen. (You may have hyperlinks for at, below, or above expected or you may only see unknown). The goal will be to look at those in the unknown, below expected, or above expected columns.
iv. You can then download each list as csv.
v. The download will show you the charge and allowed amounts. You can then identify if any of your charges equal your allowed amount or are below your allowed amount.
vi. We recommend updating your fee schedule to be above your allowed amount.
