Derived Fees in Detail

Overview

Bluechip calculates charges and benefits for services according to how you configure your Service Items. Some Medicare Service Item fees are based on calculations that take into consideration;

o The number of patients seen

o The number of fields

o The percentage % or fixed fee of an Associated Service

o The time taken for the service

In regards to the Derived Fee types available for selection with a Service Item, these include:

o Patient

o Field Quantity

o Associate Item

o Time

In order to factor-in the number of patients when billing Derived Fees, an initial configuration of Derived Fees is required within Bluechip’s ‘Practice’ options, and ‘Class’ options.

These instructions guide you through the configuration of these options in order to bill Derived Fees, and then how to issue an invoice that includes Derived Fees to Medicare.

We examine;

o Configuring Practice Options to allow ‘Number of Patients’ in invoice items (one time setup only)

o Configure Class options (one time setup only)

o Access Service Items to view the Derived Fee setup (automatically configured)

o The setup and billing process for Derived Fees, which covers;

• Patient

• Field Quality

• Associate Item

• Time

Step 1: Configuring Practice Options

To enable Bluechip to bill a number of patients for the Derived Fee Type Patient, the option 'Allow number of patients in an invoice' must be selected within the Practice Options setup.

1. Within Bluechip, select Setup > Practice > Options, and then select the Billing and Fees tab.

2. In the Invoices section, tick the Allow number of patients in invoice items check box, and then click

Step 2: Configuring Class Options

For you to be able to invoice derived fees for a given Class, you must first activate the following options for that Class;

o Allow Number of Patients

o Use Equipment

o Allow Quantity

This enables billing for multiple patients, and activates the ‘Quantity’ and ‘Equipment’ fields on an invoice.

1. Within Bluechip, select Setup > Practice> Classes. The Class Setup window appears.

2. From the Account Class list, select the appropriate Class. For example, ‘Bulk Bill’.

3. On the General tab, tick the Use Equipment and Allow Quantity options if billing for Derived Fee Types Field Quantity and Time.

4. Select the Payment Option tab, and tick the Allow number of patients option if billing for Derived Fee Type Patient.

5. Click

o Repeat the above for all Classes that require Derived Fee billing.

Step 3: Access Service Items to View the Derived Fee Setup

Bluechip does NOT require any Derived Fee configuration to be completed by the Practice. This is because the MBS/RMFS/Health Fund Fee Update automatically configures Derived Fees for you.

As such, it is imperative that the Derived Fees setup is not altered in any way.

The Derived Fee configuration is setup automatically during the MBS / Health Fund Fee Update. This fee list includes Derived Fee Types and calculations. Derived Fee Service Item types are automatically determined, and calculations are generated from the fee lists. The Derived Fee setup will transfer to the invoice automatically, streamlining your Derived Fee billing.

The following information requires no action on your part, and is presented for educational purposes only, to demonstrate how MBS and Health Fund Fee Updates are automatically configured for your Practice. The Derived Fee Billing Section is provided to assist with your billing (action).

1. Within Bluechip, select Setup > Lists > Service Items. The Service Item Lists window appears.

2. Select a Fee List you wish to view Service Items for, and click The Service Items window appears.

3. In the Filter by Item field, enter the required Service Item number, and then click

4. The Edit Derived Fee Details window appears.

o If the selected fee is a Derived Fee, the Type and Fee Calculations generated from the MBS and Health Fund Fee Update are displayed:

o If the selected fee is not a Derived Fee, you will be notified of such:

Step 4.1.1: Derived Fee Type - Patient Setup

As such, it is imperative that the Derived Fees setup is not altered in any way.

The Derived Fee type ‘Patient’ refers to a fee calculation based on the number of patients seen (sometimes known as ‘multiple patients’). A maximum number of patients can be set, and then, for each of the patients a schedule, 75% and/or 85% fee can be customised.

(No Action Required – Automatically Configured)

From the Edit Derived Fee Details window, locate the Derived Fee Type drop-down list, and select ‘Patient’.

1. Enter the required Maximum number of patients. A corresponding number of fee columns is generated automatically for you.

o The maximum number of patients is 99. Anything over 7 patients will calculate with the same derived fee.

2. For each # Patient, enter the Fee ($ value) required in the associated fee column (Schedule Fee, 75% Fee and/or 85% Fee). Ensure all # Patient (#1 to 7) fees are established and entered.

o If the maximum number of patients is >7, the fee will be generated automatically, as the # Patients 7 fee for each additional patient.

3. Once all fees are entered, click

Repeat this procedure for all service times that require configuration for Derived Fees (Patient billing). Be sure to search the required service item prior to starting this procedure.

Step 4.1.2: Derived Fee Type - Patient Billing

Derived Fee Patient configuration assists with billing Service Items for multiple patients, automatically calculating the derived fee per patient. Where this is greater than 7 patients, the same derived fee is calculated.

1. Within the Patient Details window, select the Accounts margin menu, and locate an existing account.

o If one exists, double-click to open it. Proceed to Step 4.

o If one does not exist, create a new account by clicking Proceed to Step 2.

2. The New Account window appears. Select the required Practitioner, and Class, and then click

3. The Account Details window appears. Complete details if required, or click

o If either the Practitioner or Class has been selected incorrectly, click to display the New Account window again for correct selection.

4. Open the appropriate Account, and then click to begin issuing a new invoice.

5. The Medicare Verification window appears. Click to verify.

6. Select the Service Type if required. There will only be multiple service types if you have pre-configured this.

o If issuing as an Eclipse (IMC) Claim, Service Type must be selected as ‘General Services’, to cater for Medicare rules. If submitted as ‘Specialist’ the claim will be rejected by Medicare. The Medicare rejection description is as follows: Error 402: Benefit not payable- number of patients attended required.

7. Enter the appropriate Service Date and Derived Fee Service Item Number. #Patient 1 derived fee will populate automatically. Ensure to select In Hospital Services for in hospital fee to populate.

8. Tab to the Service Text field, and then double-click the field to reveal the field to reveal the icon. Click the icon to add text for Medicare if required, and then click

9. For the second patient; enter the Derived Fee Service Item Number with a slash and the patient number. For example: 24/2, and then tab on your keyboard. #Patient 2 derived fee will populate automatically.

10. Repeat the above step for each additional patient required to be included in the derived fee invoice. Ensure to utilise the service text field if required.

11. Once all patients are included in the invoice, click

Step 4.2.1: Derived Fee Type - Field Quantity Configuration

MedicalDirector Bluechip does NOT require any Derived Fee configuration to be completed by the Practice. This is because the MBS/RMFS/Health Fund Fee Update automatically configures Derived Fees for you.

As such, it is imperative that the Derived Fees setup is not altered in any way.

The Derived Fee type ‘Field Quantity’ allows for fee calculation based on the number of fields treated. A base service item fee is entered, and then allocated a maximum field quantity for derived fee service items. For each Quantity increment, a schedule, 75%, and/or 85% fee can be customised for specialised fields like Radiology, Radiation Oncology, etc.

The configuration of ‘Equipment’ is required in order to reveal the Equipment drop-down menu in Derived Fee billing.

Depending on the preferred billing process for Private claims for Derived Fee Field Quantity (refer to the next section – Field Quantity Billing), if the practice does not want to charge a private patient a gap (a base item fee), and would prefer not to have to amend each invoice, the Practitioner’s private fee list requires configuration with the Derived Fee.

(Steps 1 to 4 - No Action Required, Automatically Configured)

1. Ensure to search for the required Derived Fee item, not the Base Fee item. For example, the derived fee item is 15003, the base fee item is 15000.

After clicking , within the Edit Derived Fee Details window, locate the Derived Fee Type drop-down list, and select ‘Field Quantity’.

2. Enter the required Base Fee Item and the Maximum Quantity required.

o 2 or more fields and up to a maximum of 5 additional fields.

3. For each # Quantity increment, enter the Fee ($ value) required in each of the Schedule Fee, 75% Fee, and/or 85% Fee columns. Ensure all # Quantity (#1 to 5) fees are established and entered.

o The derived fee calculation = the Base Fee Item (15000) + each field in excess of 1. When a fee update is run, derived fees will automatically update.

4. Once all fees are entered, click Repeat this procedure for all service times that require configuration for Derived Fee (Field Quantity) billing. Ensure to search for the required derived fee service item prior to starting this procedure.

5. To setup Equipment for billing, select Setup > Lists > Equipment. The Equipment Setup window appears.

6. Click The New Equipment window appears.

7. Enter information for the piece of Equipment:

o Equipment Abbreviation: abbreviation name (entry is mandatory and must be unique).

o Medicare Equipment ID: ID is optional. Displays on the claim (must be unique and requested by Medicare if it does not already exist).

o Equipment Description: expanded name or description of the piece of equipment (optional entry).

8. Click If Private Class Derived Fee setup is not required, setup is complete (skip steps 9 through 12).

9. If you wish to setup the Private Class with Derived Fees (to auto-populate the fee), select Setup > Practitioner > Practitioner Details.

10. Select the appropriate Practitioner, and then select the Fees tab. Locate the Class section, and select ‘Private’.

11. Enter the Derived Fee Item into the Filter Service Item, and then enter the Derived Fee (additional fee amount only) into the Fee field (located on the right). To save changes, click onto the item number within the list.

o Repeat this step for each service item that requires the Derived Fee setup for the Private Class.

12. Once setup all required derived fees required, click

Step 4.2.2: Derived Fee Type - Field Quantity Billing

Derived Fee Field Quantity configuration assists with billing; the base item is considered, and then the field quantity is factored-in, to automatically calculate the derived fee per quantity. With this calculation, a maximum of 6 fields are payable (the base field + 5 additional fields).

There is a variance to how Medicare handles Derived Fee Field Quantity claims with Bulk Bill/DVA to Private claims:

o Billing for all claim types: both the Base Item and the Derived Fee Item must remain the auto-populated fee generated from the Derived Fee setup.

o Billing a Private claim: you have a choice as to how you issue the claim. Private claims are seen like a paper claim. Scenario:

• Enter the Base Item and Derived Fee Item and accept the auto-populated fees generated from the Derived Fee setup.

• Patient paid the account in full.

• Medicare will not pay the Base Item of the claim, so the unpaid portion becomes a Gap value for the Practice. Otherwise, amend the Derived Fee item to the additional Derived fee amount only (portion amount) - no Gap amount exits for the Patient.

• Medicare will accept both Base Item and Derived Fee Items and pay the claim.

All Online Claims (Bulk Bill, DVA, Patient Claim, Eclipse)

When Medicare payment is received for Bulk Bill/DVA and Private Claims (only Private claims when the Derived fee amount was not amended), Medicare calculates and handles the claim and as follows:

o Medicare does not pay the Base item, and generates a reason code message. Example error message: ‘253 – Radiotherapy assessed with other item number on the voucher’.

o Then Medicare Accepts the Derived item number and pays the amount (base item fee + derived item fee) and generates a reason code message. Example acceptance message: ‘516 – Benefit paid for base and derived radiotherapy items claimed’.

Due to how Medicare handles the payment for the above scenario, MBS and RMFS fee List cannot generate a base item fee as $0.00. So, for a Private Patient the unpaid base item fee generates as a Gap value for the Practice.

Private Claims

When Medicare payment is received for Private claims (if the Derived Fee has been amended to additional Derived Fee only), Medicare calculates and handles the claim and as follows:

o Medicare Accepts both Base Item and Derived Fee item number and pays amount (due to the amendment - No Gap)

1. Within the Patient Details window, select the Accounts margin menu, and locate an existing account.

o f one exists, double-click to open it. Proceed to Step 4.

o If one does not exist, create a new account by clicking Proceed to Step 2.

2. The New Account window appears. Select the required Practitioner and Class, and then click

3. The Account Details window appears. Complete details if required, or click on the button.

o If either the Practitioner or Class has been selected incorrectly, click the Cancel button to display the New Account window again for correct selection.

4. Open the appropriate Account, and then click to begin issuing a new invoice.

5. The Medicare Verification window appears; click to verify.

6. Select the Service Type if required. There will only be multiple service types if you have pre-configured this.

7. Enter the appropriate Service Date and Base Service Item Number (15000). Quantity of 1 and Base Item Fee will populate automatically.

8. Tab to the Service Text field, and then double-click the field to reveal the button. Click the button to add text for Medicare if required, and then click

9. Enter the Derived Fee Service Item Number (15003). Quantity of 1 and Derived Item Fee will automatically populate (base item fee plus excess of 1).

10. Change Quantity field to the required quantity, and select the Equipment from the drop down menu. This will automatically calculate the Derived Fee total. Ensure to utilise the service text field if required.

11. There are two scenarios for this step:

o If billing a Bulk Bill or DVA claim, ensure not to amend the Fee amounts of either item. Medicare will reject the Base item and pay the Derived Fee amount only. For example, Medicare payment will received will be $50.70 for quantity of 1, $79.75 for quantity of 3.

o If billing a Private claim, you can leave the auto-generated amounts (the Base Item amount becomes the Gap to the practice), or amend the Derived Fee amount to the additional portion amount only of the Derived Fee. For example,: amend the item 15003 fee to $17.10 for quantity of 1, $51.30 for quantity of 3.

A Derived Fee for the additional Derived Fee amount can be setup in Practitioner Details > Private Fee list. This will automatically populate the additional Derived Fee amount in a Private Account, so the item would not require amending in each claim. Refer to the Derived Fees – Field Quantity Setup section.

12. Click

Step 4.3.1: Derived Fee Type - Associated Item Setup

MedicalDirector Bluechip does NOT require any Derived Fee configuration to be completed by the Practice. This is because the MBS/RMFS/Health Fund Fee Update automatically configures Derived Fees for you.

As such, it is imperative that the Derived Fees setup is not altered in any way.

The Derived Fee type of ‘Associated Item’ provides the facility to bill a service item where the fee applied is entered as a percentage or fixed fee on other service items fees (invoiced and/or non- invoiced).

For example, the service item (and its fee) is based on one or more Associated Service Items.

Prior to invoicing an Associated Item, the service item is flagged as an Associate Item.

(No Action Required - Automatically Configured)

1. After clicking , from the Edit Derived Fee Details window select the Derived Fee Type of ‘Associated Item’.

2. Click This service item is now flagged as an Associated Item.

Step 4.3.2: Derived Fee Type - Associated Item Billing

Derived Fee Associated Item setup is to assist; billing or creating an estimate with an Associated Item with a $0.00. This will enable the item to be manually calculated as a percentage or fix fee with the invoice.