Contracted Charges

A facility contract is an agreement with a facility for a dollar amount that the facility will reimburse your company for services, supplies, and procedures. This is different from charge rates. The contracted facility amount is the amount the facility agreed to pay your company while the charge rate is the amount your company charges.

You create a facility record as you work claims. Once in the system, click Facilities on the navigation bar to view a facility list. Click on the facility name to add contracted charges and mileage.

Contracted charges

Contracted charges override your company’s standard charges and will be applied to any claim billed to this facility.

Use the following steps to add contracted charge amounts. Once the charges are configured, you can use these same steps to edit or delete a contracted charge.

On the navigation bar, click Facilities.
Click the All facilities tab.
Scroll down the list and click the facility name.
Click the Contracted charges tab and then click Edit.
Click the calculation method field and select the method you want to view.

Select Flat amount per HCPCS to add or change the contracted price per unit.

Select % of Medicare fee schedule to set the percentage level.
Click Save changes.

Contracted facility mileage rounding

To set a the contracted mileage for a facility:

On the navigation bar, click Facilities.
Click the All facilities tab.
Scroll down the list and click the facility name.
Click the Mileage tab and then click the Edit pencil next to the Contracted mileage heading.
Click the "Mileage rounding" field and then select an option from the list.

Note: If the primary payer on a submitted or completed claim is changed and the new payer uses a different mileage rounding type, the original mileage charge is obsoleted, and the new payer's mileage rounding setting is applied to the claim.
Click Save changes.