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Calculator Results Explained

The California Official Medical Fee Schedule (OMFS) Calculator instantly provides the correct reimbursement for a Bill based on Date of Service.

Here’s how it works:

A. OMFS

B. Allowed

C. Balance

D. Fee Schedule Percent

E. Detailed Explanation

F. To clear a calculation, click ‘New Calculation’

G. To print or save the current calculation, click ‘Download PDF’

H. To edit the current calculation, click ‘Edit’

A. OMFS

The mandated reimbursement amount per California’s Official Medical Fee Schedule (OMFS). The OMFS is calculated using the fee schedules in effect for the entered Date of Service. The OMFS reimbursement amount incorporates fee-affecting workers' comp billing ground rule calculations (eg., surgical cascading, MPPR, NCCI, MUE) and modifiers. OMFS reimbursement amount does not calculate contracted or network discounts.

B. Allowed

The reimbursement amount allowed by the claims administrator as reported on an explanation of review (EOR) and entered in the Total Allowed field on the previous screen. If not provided, this optional field defaults to $0. The Allowed amount is used to calculate the Fee Schedule Percent.

C. Balance

The OMFS reimbursement amount minus the amount entered in the Allowed field. Balance represents the OMFS reimbursement amount minus the Allowed amount.

D. Fee Schedule Percent

Calculation of the amount in the Allowed field divided by OMFS reimbursement amount. Viewing Fee Schedule Percent helps quickly identify discounts being taken by the payer.

E. Detailed Explanation

Provides information about each Procedure Code in addition to information about the code’s relation to other Procedure Codes calculated with it.

Detailed Explanation includes:

  • OMFS Calculation Details
  • Billing Ground Rules
  • CCI Edits
  • HCPCS Information

F. To clear a calculation, click the ‘Calculator’ tab

Click Calculator to clear the current calculation and begin a new one.

G. To print or save the current calculation, click ‘Download PDF’

Creates and opens a PDF of the current calculation and Detailed Explanation to be printed or saved.

H. To edit the current calculation, click ‘Edit’

Click Edit to make changes to the current calculation and update the Detailed Explanation.

Accurate calculations in seconds!

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