An Expected Fee Schedule Calculation explanation is provided for each Procedure Code entered. This Detailed Explanation provides information about the calculation factors daisyBill uses to determine OMFS reimbursement.
Let’s break down a detailed Fee Schedule Calculation.
A. Fee Schedule
The Procedure Code falls under this Fee Schedule.
B. Description
A short Description of the Procedure Code.
C. Effective Dates of Service
The Effective Dates of Service provides the Dates of Service the calculated OMFS reimbursement amount is effective. The Outpatient ASC Calculator calculates accurate reimbursement for dates of service 12/15/16 to present.
D. Base Calculation Explanation
Provides the Relative Weight (applicable on Date of Service), Conversion Factor and Multiplier for each Procedure Code.
For more information see §9789.33. Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule - Determination of Maximum Reasonable Fee.
E. Base Maximum Fee
The Base Maximum Fee is the maximum reimbursement per the OMFS for the Procedure Code on the given Date of Service. The Base Maximum Fee does not include calculations for Billing Ground Rules (eg., surgical cascading, status codes, etc). The Base Maximum Fee may differ from the Expected reimbursement calculated which does account for Billing Ground Rules.
For detailed information regarding the calculation of the Base Maximum Fee see §9789.33. Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule - Determination of Maximum Reasonable Fee.
F. Base Maximum Fee Exceptions
Base Maximum Fee Exceptions are fee affecting regulations that determine the calculated OMFS reimbursement. Base Maximum Fee Exceptions are applied to the Base Maximum Fee calculation to produce the OMFS reimbursement.
For detailed information regarding applicable Base Maximum Fee Exceptions see §9789.33. Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule - Determination of Maximum Reasonable Fee.
G. Addendum B - OPPS Payment HCPCS Code
Addendum B - OPPS Payment HCPCS Code provides values from CMS Addendum B including the CMS filename in which they can be found.
H. Addendum D1 - OPPS Payment Status Indicator
Addendum D1 - OPPS Payment Status Indicator provides values from CMS Addendum
D1 including the CMS filename in which they can be found.
Now back to beautiful billing!