Using Your Physician Charge & Payer Analysis (PCPA) Tool
For the State(s) and Locality(s) of your choosing, you are going to receive all AMA-approved CPT® Codes (2011 – 2017) and related $ allowable data. When you open your PCPA Tool you will see three worksheets;
Charge Entry Worksheet
Add New % of Medicare Payer Fee Schedule
(1) From the Charge Entry w/s, click Add New % of Medicare Payer Fee Schedule, this new Payer will be auto-added to the Charge Entry w/s to compare Physician’s Charges and Payer Allowables.
(2) You’ll then see a dialogue box like this one, enter the Payer Name, i.e. BCBS and click OK.
(3) The following form will come up. Select the Year of Medicare and enter Percent’s, click OK.
(4a) Two things will happen; 1st, a w/s (BCBS) will be auto-added at the bottom of the workbook with the other worksheets.
(4b) 2nd, BCBS will be auto-added to your Charge Entry w/s. You can click on the BCBS w/s and change the Year of Medicare and Percent’s if you like, your Charge Entry w/s will be auto-updated for you. Cells will stay red until Physician’s Charges exceed the contract allowable (preventing undercharges).
(5) Use the buttons at the top of your w/s to Calculate Totals or Go to … (to go to a specific CPT® code). Click Calculate Totals to refresh after each data-entry. You may also use the filter located next to CPT® Code, you select all the codes you want to see and it automatically hides the rest. Do not delete any rows on your Charge Entry w/s.
Add New Proprietary Payer Fee Schedule (PPFS)
(1) From the Charge Entry w/s, click Add New Proprietary Payer Fee Schedule, this new Payer will be auto-added to the Charge Entry w/s to compare Physician’s Charges and Payer Allowables.
(2) You’ll then see a dialogue box like this one, enter the Payer Name, i.e. Aetna and click OK.
Note: When adding a PPFS – there will not be a separate w/s (i.e. BCBS) for that Payer, as you are uploading data or performing edits directly on the Charge Entry w/s. It is entered here for your Contract Inventory w/s.
(3a) If No – perform your $ allowable edits directly on the Charge Entry w/s for that Payer.
(3b) If you select Yes, you will Upload a saved file from your computer. See (4).
(4) If you Upload data it must be in the format below, the w/s must be labeled PPFS, name the file whatever you wish.
Column A – CPT® Code, Column B – Modifiers 26 and TC, Column C – Payer $ Allowable. These will be placed appropriately on your Charge Entry w/s.
Contract Inventory Form
Adding a Payer to your Contract Inventory w/s.
(1) The Contract-Payer is auto-added for you from your New Payer dialogue box.
(2) You will notice that there is sample data in row 10 of your Contract Inventory w/s, do not delete this, when you complete your 1st Contract Inventory form it will replace the sample data that is currently there.
(3) You may edit the data on the Contract Inventory w/s after completing the Contract Inventory form.
(4) Use the buttons on your Contract Inventory w/s to sort the data and determine which contracts need attention and when.