Enter Standard Rates & In-Network Rate Schedules (Tutorial)

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TherapyNotes allows you to enter standard rates as well as your contracted in-network rates for each service code. Standard rates automatically populate in billing items for out-of-network payers. You have the option to use standard rates for in-network payers, or create in-network rate schedules per payer. If different clinicians have different contracted in-network rates, you can create different rate schedules and assign them to the appropriate clinicians. This article overviews how to add standard rates, how to use standard rates for in-network payers, how to add a custom in-network rate schedule, and how to assign rate schedules to clinicians.

For general information about service code rates, see this article

To learn how to add custom rates per service for patients that do not use insurance, see this article. 

 

Standard Rates for Out-of-Network Payers 

Standard rates are entered in each service code's settings and autofill billing items associated with out-of-network payers. To learn how to add, change, or delete a service code, see this article.

Have a Practice Biller, Practice Administrator, or Clinical Administrator complete the following steps. 

  • Click the User Icon > Settings > "Service Codes" 
  • Click on the service code itself. 
  • Enter the rate in the "Standard Rate" field. 

  • Click the green "Save Changes" button. 

These rates automatically populate out-of-network billing items. If a rate does not auto-populate for an out-of-network billing item, go into the service code's settings and enter a standard rate. 

 

Standard Rates for In-Network Payers 

The standard rates can be used for in-network payers. Even if you use standard rates for services on claims to in-network payers, insurance will pay the contracted rate. Sometimes in-network payers increase your contracted amount. If you bill with your standard rate, which is typically higher than your contracted rate, insurance will pay the new, higher amount. If you use your contracted rate, they might not inform you that they increased your contracted amount. However, they will continue to pay you the lower, old rate since that is what is listed on the claim. 

To apply the standard rates for an in-network payer, have a Practice Biller complete the following steps. 

  • Click PAYERS > Click payer > "Rate Schedules" tab 
  • Check the "Use Standard Rates" box

  • Click the green "Save Changes" button. 

 

Custom Rate Schedules for In-Network Payers 

Step 1: Set Custom Rate Schedule 

If you wish to use your contracted in-network rates instead of the standard rates, have a Practice Biller or Practice Administrator complete the following steps. 

  • Click PAYERS > Click payer > "Rate Schedules" 
  • Make sure the "Use Standard Rates" box is not checked

  Enter a name in the "Rate Schedule Name:" field. 

  Enter the contracted rate in the "Custom Rate" field for each service code. 

  Click the green "Save Changes" button. 

Note: Another option is to add in-network rates per payer in the service code settings.

 

Step 2: Assign Rate Schedule to Clinicians

If there is only one in-network rate schedule for a payer, all clinicians will automatically be assigned the rate schedule. If there are multiple rate schedules for an in-network payer, the Practice Biller needs to assign the rate schedule per clinician. To learn how to assign rate schedules per clinician, see this article

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Comments

  • Avatar
    Urminda Firlan

    The following instructions from TN above are still not bringing up the rate for my out of Network Providers. Please go into my account to let me know why...

    Standard Rates for Out-of-Network Payers

    Standard rates are entered in each service code's settings and autofill billing items associated with out-of-network payers. To learn how to add, change, or delete a service code, see this article.

    Have a Practice Biller, Practice Administrator, or Clinical Administrator complete the following steps.

    Click the User Icon > Settings > "Service Codes"
    Click on the service code itself.
    Enter the rate in the "Standard Rate" field.

    Click the green "Save Changes" button.

    These rates automatically populate out-of-network billing items. If a rate does not auto-populate for an out-of-network billing item, go into the service code's settings and enter a standard rate.

  • Avatar
    Jordan

    Urminda,

    I will have an agent reach out to you in regards to this inquiry about your out of network rates. Thank you.