The Filopto Billing Rules can use the CMS Medicare Physician Fee files to bill Medicare Claims automatically using the Medicare Fee Schedule for your location.
The USA Medicare fee schedule can be manually entered or uploaded using the ANNUAL PHYSICIAN FEE SCHEDULE PAYMENT AMOUNT FILE (DOWNLOAD VERSION) available from your Medicare provider or from the CMS WEB Site (http://www.cms.gov). Uploading the file into Filopto can take several hours.
Before using this file make sure you understand how Medicare or other carriers use the ANNUAL PHYSICIAN FEE SCHEDULE PAYMENT file.
To locate the file on the national web site follow these steps:
Warning:
The following steps are provided for your information as is, and was correct at the time of the writing of this help file. The CMS web site may change or move the location, content or requirements to download these files. These files contain material copyrighted by the American Medical Association, CPT codes and descriptions only are copyright by the American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
The Fee Schedule are updated on a regular basis, you must update the fee schedule used by Filopto when appropriate for Filopto to function properly.
Updated files are ty Typically available on April 1, July 1, and October 1 (subject to change).
|
How to Get the USA Medicare Fee Schedule
Go to the website: http://www.cms.gov G or use the get Medicare Fee Schedule here (9) button to go to the CMS site.
1- Select the Medicare tab
2- Select "Physician Fee Schedule" section on the left-hand side.
3- Select "PFS Carrier Specific Files" in the "Resources for Providers" section.
4- Select and sort by "Calendar Year" in the "PFS Carrier Specific Files" section.- sort the column Calendar Year in descending order which will place the current year at the top of the list
5- Select the current "CY XXXX(year)" All States File
6- Download and Save the zip (compressed file to a location on your PC. Unzip (uncompress) the downloaded file. The downloaded file contains a PDF file with instructions, update schedule for the file and all of the state local files as well as one file that contains all states. For Filopto we recommend that you use the PFALLXX (XX represent the year) file for all states or PFYYXX (YY represent the state) for a state specific file.
Important:
The PFALLXX file is for all states and can be about 100MB in size. Depending on your server it can take several hours to load the file. State files are smaller and will load much faster.
|
7- Go to the Billing Rule for Policy Fee Schedule screen and press the Import Medicare Fee Schedule button.
8- You will be asked to select the file to use for Medicare (folder location of the downloaded file). You must point to the folder where the unzip text file is located, select the PFALLXX (XX represent the year) file (for all states or PFYYXX (YY represent the state) for your specific state and press the open button. The upload process can take several minutes depending on the size of the file being processed.
Medicare Participating Provider Fee Schedule
If the selected provider is a Medicare Participating Provider, You must place in the Employee Profile - Insurance section (Employee Manager) a check mark in the box identifying that he is a Participating Medicate Provider. By placing a check mark, it tells Filopto Billing Rule engine to use the Medicare Participating Provider rate versus the Medicare Non-Participating Provider rate when using the Medicare schedule entered in the Policy Fee Schedule billing rule option. In a multi-provider office the check mark must be entered or not for each provider in each provider employee profile.
IMPORTANT:
For organizations having multiple offices and using different carriers for medicare payment, create an insurance company for each separate Medicare carrier. In this way each claim can be specifically rated using the different Medicare Fee schedule associated with each Medicare carrier / Individual Insurance company profile.
|
