Skip to main content

​
At a Glance

Adding or updating your Self-Pay Fee items will allow Insights to automatically generate Patient Responsibility (PR) charges for self-pay patients, based on your organization’s established rates for specific CPT codes. A self-pay fee schedule will free up considerable time for your administrative staff, as they will no longer need to manually look up CPT codes and rates. What you can do on your own — Add or edit items in your schedule line by line, or upload a schedule with multiple items at once using Bulk Submit CSV. What you can do with help from an account manager — If you would rather have a large or unfamiliar schedule reviewed before it goes live, your account manager can check the file and upload it for you. You can select whether you want post-visit PR generated for self-pay patients, based on your fee schedule. Update PR Post-Visit Based on Self-Pay Fee Schedule controls this: select No and no post-visit PR is assigned to the patient, or select Yes and any excess calculated during reconciliation is charged as PR — if the pre-appointment collection exceeds the charge from the fee schedule, the difference is assigned as credits instead. You can also choose the earliest date of service to which the fee schedule would apply, as well as a maximum self-pay charge per encounter. Only reconcile self-pay collections after limits reconciliation to collections on or after the date you pick, so historical encounters are left untouched. Generated self-pay PR then appears on the patient’s Patient Responsibility account alongside other PR.
If a CPT code’s self-pay fee is $0, the Encounter and Claims pages suggest the corresponding professional fee schedule amount. Review the suggested charge before you save it.
Self-pay fee schedule settings for post-visit patient responsibility charges

​
How to Do It

From the Patient Responsibility page, click the ‘Actions’ menu and choose PR Settings. Patient Responsibility Actions menu with PR Settings Click on the Self-Pay Fee Schedule tab. You may have to scroll the list of tabs to the right in order to see this tab. From here, you can either use the Search function to find a CPT if you already have items in your fee schedule. For this walkthrough, start by clicking Add Single Fee. Self-Pay Fee Schedule tab with the Add Single Fee action In the Add Row dialog, fill in:
  • CPT code and any Modifiers.
  • Facilities (optional) — leave this empty to apply the fee across all facilities, or select specific facilities when the price differs by location.
  • Fee in cents — the amount to charge in USD cents.
  • Start date of service and, if the fee is time-limited, End date of service.
CPT modifiers (also referred to as Level I modifiers) are used to supplement the information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition. They are typically formatted as two characters, separated from other modifiers by a comma (For example: AB, CD) Form for entering a CPT code, modifiers, and self-pay amount Click Confirm. Now you can view your new item in the fee schedule. Self-pay fee schedule with a newly added line item Click the pencil icon to modify the charge amount of the item, and the trash can to delete the item entirely. ❗ You will only be able to edit the charge amount of each item. If you would like to edit either the CPT code or modifiers, simply delete the item and add a new one.

​
Bulk Upload with a CSV

If your site prices a large number of CPT codes, upload the whole schedule at once instead of adding rows individually.
  1. In the fee schedule table, click Bulk Submit CSV.
  2. In the Upload Self-pay Fee Schedule dialog, click the here link to download a correctly formatted example CSV, then build your file to match it — the same columns shown in the fee schedule table.
  3. Drag and drop your CSV into the upload area, or click Choose to browse for it.
  4. Click Upload.
✨Smart Tip: Check your work — after uploading, review the rows in the fee schedule table and search by CPT to confirm a specific code priced correctly. Use Download Fee Schedule to export the current schedule when you need to audit it or use it as the starting point for your next update.

​
Duplicate CPT Codes and Modifiers

If you input an exact duplicate CPT code and modifier combination but with a different charge amount, the original will simply be updated. If, however, you have a single CPT code, but different modifiers requiring different prices, the system will create a new line item. Self-pay fee schedule showing CPT codes with different modifiers

​
Download Your Practice’s Self-Pay Fee Schedule

In PR Settings, under the Self-Pay Fee Schedule tab, you can click Download Fee Schedule below the listed items in the fee schedule to get a CSV file. The data in this file can be viewed and manipulated in Excel or similar program. Download Fee Schedule action in Self-Pay Fee Schedule settings

​
Further Assistance

We’re here to help! Please get in touch with support@getathelas.com if you’d like some hands-on assistance.

​
FAQ

Insights suggests the corresponding professional fee schedule amount on the Encounter and Claims pages. Review the amount before you save the service line.
No. Delete the existing item and add a new one with the correct CPT code or modifiers. You can edit only the charge amount on an existing item.
Yes. In the fee schedule table, click Bulk Submit CSV, download the example CSV from the here link in the upload dialog, build your file to match those columns, then drag it in or browse for it and click Upload.