Chapter 12: Fee Schedule, HIPPS & Service Codes
Chapter Overview
What You'll Learn:
- Where rates live (on the payer, not on a branch)
- Which rates tab appears for each claim billing mode
- How to add fee-schedule rates, HIPPS rates, or service codes
- Catalog / platform-managed locks
Time to Complete: 15–20 minutes
Who Should Read This: Agency Administrators, Billers
Prerequisites: Chapter 6: Payer Setup
Text-only. Labels match the screen.
12.1 Where to Work
- Open Payer Setup (Settings or sidebar Setup → Payer Setup).
- Open a payer.
- Use the profile/enrollment tab, then the rates tab for that payer’s mode.
Claim billing mode options you may see on payers:
- Medicare PDGM (HIPPS)
- Per visit (fee schedule)
- Unit based (service codes)
12.2 Which Tab Appears
| Claim billing mode | Rates tab label |
|---|---|
| MEDICARE_PDGM | HIPPS Rates |
| UNIT_BASED | Service Codes |
| Per-visit / other | Fee Schedule |
Profile side:
- Catalog / platform-managed → Enrollment
- Custom → Profile & Rules
You do not always see Fee Schedule + HIPPS together — usually one rates tab for the mode.
12.3 Fee Schedule (per-visit)
Title: Fee Schedule. Button: Add Rate (hidden when platform-managed / locked).
Add Rate to Fee Schedule fields:
- Visit Type *
- Rate ($) *
- Effective Date *
- End Date
- Status (Active / Inactive)
Table columns: Visit type · Rate ($) · Effective date · End date · Status
12.4 Service Codes (unit-based)
Used for Medicaid/ODM-style UNIT_BASED payers (and billing-only catalogs).
- Button: Add Service Code (when editable)
- Columns include: Display name · Code · Discipline · Unit type · Base rate · Unit rate · Status
- May show an ODM rates chip
- Nested dated rates: Effective / End / Base / Unit / Status
Add Service Code fields typically include:
- HCPCS code *
- Discipline *
- Service name *
- Display name (scheduler label) *
- Unit type *
- Requires EVV
- Use ODM contract rates (same HCPCS) when applicable
These codes drive scheduling hours/units and New Claim lines.
12.5 HIPPS Rates (Medicare PDGM)
- Button: Add HIPPS Rate (when editable)
- Columns: HIPPS Code · Description · Rate · Effective Date · Actions
- Fields: HIPPS Code, Rate, Effective Date, Description
12.6 Catalog / Platform-Managed Locks
For Betasky catalog payers marked platform-managed:
- Add Rate / edit / delete on rates may be hidden
- Enrollment may note that rates/service codes are managed by Betasky
- Agencies still manage contract dates, provider IDs, and clearinghouse enrollment (Chapter 6)
12.7 Common Mistakes
- Looking for fee schedules under Branch Management — rates are on the payer.
- Expecting Fee Schedule + HIPPS + Service Codes all at once — tab follows claim billing mode.
- Trying to edit locked catalog rates — use catalog enrollment, not local overrides.
- Forgetting effective dates when rates change mid-year.
12.8 Quick Checklist
- Each active payer has the correct mode and rates tab
- Per-visit payers have visit-type rates
- Unit-based payers have service codes for scheduling/claims
- Catalog locks understood
Next: Chapter 13: Agreements & Enrollments · Chapter 14: Go Live