Multiple Fee Schedule Function Rules
The multiple fee schedule function provides a way to define one or more fee schedules tied to the Bill To options of client code, insurance code, patient (default) and cash.
A fee schedule is defined as a collection of records that assign CPT codes and prices for each test code in the system.
The FASTfront-end is not meant to be a billing system, so we assume that fee schedule data will be downloaded from the Claims (FIN) system using customized user created routines. Manual entry into the corresponding tables is also possible. FASTdoes not have fee schedule management tools since it is not a primary claims environment.
The multiple fee schedule function associates specific fee schedule codes as defined in the FO_LISxHIS table to predefined Bill To, charge to, values. The FASTBill To values are related to FIN system values but represent a concept more aligned with front-end staff and operations.
Fee schedule operations occur on the client-driven order screen and are applied when a Bill To value is selected. The system applies a fee schedule at the time an order is first created. If the order was imported from an external system, the fee schedule is applied when the order is first opened in edit mode. The system does not apply a fee schedule when an external order first arrives. This allows the most current fee schedule to be used when the order is first opened.
Note: : Make sure the correct fee schedule is used for insurances that require medical necessity rules. This is critical since the fee schedule code defines the CPT codes associated with each test in the order.
Note: FASTrequires a default fee schedule to be defined for each test code (is that true?). The default fee schedule records are created in the FO_LISxHIS table.
Systems without the multiple fee schedule function assume that the data present in the FO_LISxHIS table is a single fee schedule. The single fee schedule function does not require any definitions outside the FO_LISxHIS table default record.
If more than one fee schedule code is defined for a test code in the FO_LISxHIS table, then additional data for that test code must be entered in the following tables.
Creating Multiple Fee Schedules
To use multiple fee schedules, you must enter data into each of these tables:
FO_LISxHIS Table
This table is used to create one or more fee schedules.
Each fee schedule, each table record, is specific to this set of values:
- LisCode: Test code for this fee schedule.
- Schedule: Fee schedule code.
- Billing_Option: Billing option code within the fee schedule.
- CPT: A single CPT code.
If a test has more than one CPT code for a particular fee schedule and billing option, then there should be one record for each CPT code.
These fee schedule code and billing option code values allow for the sub-categorization of fee schedules. Both of these values must be entered correctly in the other tables listed below.
System calculations add all the CPT codes prices together to total the price for a test. The system also uses this information in medical necessity logic to assign CPT codes and prices to tests.
See FO_LISxHIS 
for more information about field definitions and allowed values.
FO_Fee_Schedule_Definition Table
This table requires one record for each fee schedule code created. Each record may have one or more records in the following FO_Fee_Schedule_Option_Definition table.
See FO_Fee_Schedule_Definition for more information about field definitions and allowed values.
FO_Fee_Schedule_Option_Definition Table
The records in this table are used to define the billing option codes for each fee schedule code defined in the FO_Fee_Schedule_Definition table.
See FO_Fee_Schedule_Option_Definition for more information about field definitions and allowed values.
FO_Ins Table
This table is used to assign a fee schedule to a specific insurance code. The codes associated are used if the insurance code is selected as a primary insurance.
The FO_Ins.BillFeeSchedule and FO_Ins.BillingOption fields specify the fee schedule codes.
See FO_INS for more information about field definitions and allowed values.
FO_Clients Table
This table is used to assign a fee schedule to a specific ordering client code. The codes associated are used if the client code is selected as an order’s ordering client code.
The FO_Clients.BillFeeSchedule and FO_Clients.BillingOption fields specify the fee schedule codes.
See FO_Clients for more information about field definitions and allowed values.
FO_LabInfo Table
- DefaultFeeSchedule and DefaultFeeScheduleOption Fields
These fields are used to denote the default fee schedule in the absence of any other association. These codes are used when an order cannot be associated with any other fee schedule.
- PatientFeeSchedule and PatientFeeScheduleOption Fields
These fields denote the codes used when a Bill To value of “Patient/Guarantor” is used for an order.
- CashFeeSchedule and CashFeeScheduleOption Fields
These fields denote the codes used when a Bill To value of “Cash” is used for an order.
See FO_LabInfo for more information about field definitions and allowed values.