The New York Calculator instantly provides the correct reimbursement for a Bill based on Date of Service.
Here’s how it works:
A. Expected Fee Schedule
B. Payment Total
E. Expected Fee Schedule Calculation - Explained
F. To clear a calculation, click the ‘Calculator’ breadcrumb
G. To print or save the current calculation, click ‘Download PDF’
H. To edit the current calculation, click ‘Edit’
A. Expected Fee Schedule
The mandated reimbursement amount per The Official New York Workers’ Compensation Medical Fee Schedule. The Expected Fee Schedule reimbursement amount is calculated using the fee schedules in effect for the entered Date of Service. The Expected Fee Schedule reimbursement amount incorporates fee-affecting workers' comp billing ground rule calculations (eg., surgical cascading, MPPR, NCCI, MUE) and modifiers. The Expected Fee Schedule reimbursement amount does not calculate contracted or network discounts.
B. Payment Total
The reimbursement amount paid by the claims administrator as reported on an Explanation of Review (EOR) and entered in the Payment Total field on the previous screen. If not provided, this optional field defaults to $0. The Payment Total is used to calculate the Expected %.
C. Balance Due
The Balance Due amount represents the Expected Fee Schedule reimbursement amount minus the Payment Total.
D. Expected %
Calculation of the Payment Total divided by the Expected Fee Schedule reimbursement amount. Viewing the Expected % helps quickly identify discounts being taken by the payer.
E. Expected Fee Schedule Calculation - Explained
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:
- Calculation Details
- Billing Ground Rules
F. To clear a calculation, click the ‘Calculator’ breadcrumb
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!