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Billing Code Default Allowed Amounts & Modifiers

When setting up your clinic billing code fees, you can also set up some handy defaults to save time, prevent billing mistakes and make your insurer Accounts Receivable more realistic. These defaults include insurer specific Allowed Amounts and billing code specific Modifiers.

Default Allowed Amounts

What is an Allowed Amount?

An Allowed Amount refers to the price an insurance company allows for a particular procedural (CPT) code. Sometimes Allowed Amounts are referred to as insurer ‘Contract Rates’ or ‘Fee Schedules’.

If entered at the time of service, Allowed Amounts can be used to help calculate patient Coinsurance as well as make your clinic Accounts Receivable more realistic. For example, if you know the insurer is going to allow less than your clinic fee for a particular billing code (and you are contractually obligated to adjust off the difference between what is billed and what is allowed), then you can add in an Allowed Amount at the time of service before filing the claim.

Note that entering Allowed Amounts at the time of service won’t affect your claim submissions! Jane does not include Allowed Amounts in your submissions (only your clinic billing code fees are used).

Why Set Up Default Allowed Amounts?

If you are in-network with an insurance company or you are just aware of what an insurance company allows, then you can add these known Allowed Amounts as defaults when setting up your clinic billing codes instead of manually adding them to each patient visit.

Note that you can set up unique Allow Amounts for each insurance company your clinic bills as well as all procedure codes billed by your clinic!

If you aren’t aware of a particular insurance company’s Allowed Amounts (or ‘Fee Schedule’), then there is no need to set up Allowed Amounts for that insurer.

How Do I Set Up Default Allowed Amounts?

First, head into Settings > Billing Codes, and either create a new billing code or edit an existing billing code as needed.

You’ll then be brought to a screen that looks this:

Every billing code will have a separate Allowed Amount box for all insurers set up on your Jane account. Once you’ve entered your insurer specific Allowed Amounts, you’ll just need to save your billing code!

How Do Default Allowed Amounts Work In Practice?

Once you’ve set up your billing code Default Allowed Amounts, Jane will consider those defaults every time you add an insurance policy to a patient visit.

For example, let’s say we’ve set up an insurer specific (Aetna) Default Allowed Amount of $110 for our clinic 99204 procedural code.

If we add 99204 to a visit that has Aetna insurance, then Jane will automatically add $110 as the Allowed Amount of that code.

To learn more about how you can use Allowed Amounts to calculate patient invoicing, click here

Default Modifiers

Why Set Up Default Modifiers?

If you bill a particular code that always needs to be accompanied by a specific modifier or modifiers, then you can have Jane automatically add those modifiers whenever that billing code is added to a visit.

How Do I Set Up Default Modifiers?

First, head into Settings > Billing Codes, and either create a new billing code or edit an existing billing code as needed.

You’ll then be brought to a screen that looks this:

You’ll notice there is a single default box where you can add modifiers to a billing code. If you’d like to add multiple Default Modifiers to a single billing code, you just need to separate those modifiers with a space.

Note that Default Modifiers aren’t insurer specific like Allowed Amounts. The Default Modifier(s) you add to a billing code will apply to all insurers.

How Do Default Modifiers Work In Practice?

Once you’ve set up a billing code with a Default Modifier, Jane will consider that default every time you add that billing code to a patient visit (just like Default Allowed Amounts).

For example, let’s say we’ve added 25 as a Default Modifier for our clinic 99204 procedural code.

If we add 99204 to a visit, then Jane will automatically add 25 as that code’s modifier.

If you have any questions about setting up Default Allowed Amounts and Modifiers we’d love to hear from you! Use the Help button from within your Jane account or email us at support@janeapp.com.