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Fee Schedules

The compensation for services rendered or to be rendered is termed as Fee Schedules. Each procedure and modality with which one or more studies are performed to the patient which is billable and each facility has its own fee structure to be levied from the patient. For different procedures and modalities, an option is available to assign specific amount as charge.

  1. Click Settings > Users and Facilities > Imaging Facilities tab.
  2. Click Facility Override Fee Schedule or Facility Override Self-Pay Fee Schedule drop-down menu. The fee schedule chosen here will be used by the facility.

Users and Facilities Imaging Facilities Tab

The fee schedule can be customized through RIS Settings > Fee Schedules. The fee schedule is classified into three sub types based on their nature of service.

  1. Procedure Fee Schedule
  2. Modality Fee Schedule
  3. Default Fee Schedule
Rules for assigning a fee schedule

The system assigns the fee schedules depending whether the patient is self-pay or has active primary insurance (Commercial, OHIP, etc.).

  1. If the patient is NOT self-pay (i.e the patient is insured) the system follows the following rules:

    a. The system first assigns the Facility Override Fee Schedule of the imaging facility.

    b. If a Facility Override Fee Schedule has not been defined for the imaging facility then the system assigns the Insurance Fee Schedule defined for the Active insurance of the patient. If the study date falls between Effective From and Effective To date of the active insurance, that insurance's Fee Schedule is assigned to the study.

    c. If an Insurance Fee Schedule has not been defined for the Active insurance then the system assigns the Default Fee Schedule to the study.

  2. If the patient IS a self-pay patient, the system follows the following rules:

    a. The system searches for the Facility Override Self-Pay Fee Schedule. If the schedule is available, then the system assigns it to the study.

    b. If the Facility Override Self-Pay Fee Schedule is not available, then the system assigns the Default Self-Pay Fee Schedule to this Self-Pay patients.

  3. After an active insurance has been assigned to a patient, the system will not allow the user to change the patient's financial type to "Self-Pay". A warning message informs the patient that the patient has an active insurance defined for him.

  4. The Default Fee Schedule tab informs the patient that the "Facility Override Fee Schedules takes higher priority than Default Fee Schedules".

The fee schedule assignment can be best described with the help of the diagram in section Fee Schedule Assignment Diagram.