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Expected Rates/Multiple Charge Masters

Expected rates allow you to include the expected reimbursement amount for each CPT Code and establish multiple fee schedules. Each table can be configured to apply to specific insurances, insurance classes, locations, providers, and procedure codes. We offer two specific reimbursement types for expected rate values: Fee for Service and Flat Rate. Each procedure code will maintain its default price (set on the Procedure Codes page), however, you can create variable prices for the same CPT Code by creating a custom charge master for each billing scenario.

Important: Expected Rates and Fee Schedules are applied based on the patient’s primary insurance. 

Create an Expected Rates Table

  1.  Navigate to the Admin menu and select Expected Rates.
  2. Click Create Expected Rates.
  3. Complete the Expected Rates table information, then click the Apply to Insurance button.
    1. Enter a Name for the schedule. You may want to include the plan type and year. Do not include any special characters.
    2. Enter a Date of Service Range. This determines the date range that the expected rates for this table should be active. This is typically a contracted date range. The Start date is required but the End date is not. 
    3. Uncheck the Include CPT Codes with no value to only view CPT Codes that already have an established Updated Billed Amount price. We recommend leaving this checked when creating new expected rate tables. 
  4. A list of all active insurances for your company will display alphabetically by Insurance Class or Insurance Code. You can select one or more insurances from the list, however, if you select by Insurance Class, the Insurance Code tab will be grayed out and vise-versa. If the insurance is grayed out, it already has an expected rate/fee schedule established for the date range.
  5. The red Apply to Insurance button turns blue after an insurance has been selected.
  6. Next, choose one or more Locations from the drop-down. Only active locations appear. If a location is grayed out, it already has expected rates established for the date range.
  7. Choose one or more Providers from the drop-down. Only active providers appear. If a provider is grayed out, they already have established fee schedules/expected rates for at least one of the insurance(s) selected for the date range.
  8. Note: Select Include Future to select all current and future Providers that may be added to the system.

Expected Rates

  1. Make a selection for the Fee/Rate. You have two options, each defined below.
    1. Fee for Service: Choose this model if you have specific, negotiated rates for each procedure and/or service performed. 
      1. Enter the exact dollar amount for the code in the Expected Reimbursement / Unit column. Important: If there is no expected rate for a specific CPT Code, leave it blank, do not enter 0.00.
      2. Check the Assistant Modifier Reduction box if you need the expected rate to be reduced when charges/CPT codes have a CO/CQ modifier. Entering a Percentage allows the expected rate configured to be reduced by the specific percentage for all CPT codes that have a CO or CQ modifier applied to it.
      3. Check the MPPR box if you need to specify a new Multiple Procedure Payment Reduction (MPPR) Rate. In order to Save a new rate, an Expected Reimbursement amount is required.
    2. Flat Rate: Choose this option when a payer only reimburses up to a specific dollar amount per visit. You also have the option to exclude specific CPT codes from this cap using the Carve-out checkbox.
      1. Enter the Per Visit rate (required) and enter the Per Eval rate (optional). The system will cap the patient’s visit to this dollar amount based on visit type. Any amount that exceeds this rate will appear as $0.00 on the patient ledger.
      2. Ensure the Expected Reimbursement / Unit column is filled out for each relevant CPT code. 
      3. For any CPT code without a rate, leave it blank.
      4. Hover over a CPT code line to select the Carve-out checkbox. If this box is checked, the system will not take into account the Per Visit cap amount and will include the full expected rate on the patient’s ledger.
  2. You can add additional expected rates schedules for the same payer(s) and date range by clicking + Add New.

Charge Masters

If you are only establishing a new charge master, you will still need to select something in the Fee/Rate drop-down, however, you don’t need to complete any other Expected Rate information as described above.

  1. Once you’ve made your selection, click on the drop-down arrow to display your company’s active CPT Codes.
  2. Fill out the Updated Billed Amount for each CPT Code. This price is what will be billed out of the system for the insurance(s), location(s), and provider(s) combo selected in this table.
    1. You can essentially render a CPT code as informational only by setting the Updated Billed Amount to $0.00. 
    2. Leave the Updated Billed Amount field blank to bill the price in the Default Billed column.
  3. You can add additional schedules for the same insurance(s) and date range by clicking + Add New. Choose your Locations, Providers, and establish those values.
  4. Click Save in the bottom right when complete.
  5. The Last Updated column populates once the table is saved.

Charge Values

Once a charge master has been established, any charges that fall into the table criteria will automatically use the Updated Billed Amount. This amount will automatically populate from the moment the charge is added or the charge enters WebPT Billing. If the charge amount is not correct when adding a charge or reviewing on the Charge Review pages, please review your Date Range, Insurance, Location, and Provider selections on the Expected Rates table.


Ledger Visit/Full

The Expected Rate Amount column is available on the Ledger Visit and Ledger Full reports on the patient’s account. These fields will only be populated if there is an expected rate established for the payer, location, provider, and CPT code. The Charges column will display the correct value for the code based on the Updated Billed Amount established in the Expected Rate table.


Edit Expected Rate Tables

You can copy or delete expected rate tables at the overall table level or at the individual location/provider level.

Copy Table

Copy Location/Provider combo


Expired Tables

The expected rate tables will automatically expire when the End Date is reached. These are preserved for historical reference in the Expired section of the Expected Rates page.

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