Edit Schedule by Range

When editing an existing lookup table schedule for a Procedure or DRG lookup table, you may do so by range of codes or DRGs rather than by individual codes or DRGs. This decreases the number of codes to examine, and allows changes to be made to the entire range all at once.

  1. Access the Edit Schedule page.
    • Select Go To > Contract Loading > Lookup Table Management.
    • To reduce the number of listed tables, enter your selection criteria and click Refresh View.
    • Click a link in the Table Name column for a lookup table checked out to you. The Edit Lookup Table page opens.
    • On the Edit Lookup Table page, click the Edit Schedule link. The Edit Schedule page opens.
    • Click the Edit Schedule by Range link. The Edit Schedule by Range page opens.  
  2. Specify the range of data to add to your lookup table.

    3. Note: The Code To field does not display for ICD-10 codes.

  3. Click Search. The range of data you selected appears; to edit individual codes, click the appropriate link in the Edit column. For more information, refer to Add or Edit Schedule Data in a Table.
  4. Optionally, click Clear to delete the data you entered and to return each field to its default value.
  5. Optionally, for a Procedure Lookup Table you may enter a value in the Adjust Rates By either before or after you click Search, in order to adjust the rates by a particular percentage.
    • Type the desired value.
    • Click Update. A dialog box opens.
    • Click OK. The Rates successfully updated message appears.

The following table describes the fields on the Edit Schedule by Range page..

Field

Description

Procedure Lookup Tables

Adjust Rates By

Percentage amount to adjust Procedure Lookup Table rates

Base Price

Price associated with the code

Code From

The low value in a range of codes

Code Range From

The low value in a range of codes to add

Code Range To

The high value in a range of codes to add

Code To

The high value in a range of codes

Code Type

The type of code included in the table

Edit

Link for editing an item

Modifier

Applicable modifier value to apply

No.

Sequential reference number of the item

Procedure Option

Type of procedure

Rev Code

Revenue code

Updated

Date, time and user information of when the lookup table was last updated

DRG Weight Lookup Tables

Capital Amount

Equipment and facilities costs for a particular DRG

Differential

The difference between the DRG reimbursement and the prevailing rate at the time of the patient's admission.

Disp. Share

Reimbursement based on Disproportionate Share Hospital operating costs (if applicable); for facilities with a disproportionately high percentage of Medicaid and Medicare SSI patients

DRG From

The low value in a range of DRGs

DRG To

The high value in a range of DRGs

Edit

Link for editing an item

High Day Trim

Fewest number of days a patient must stay in the hospital for the hospital to receive full insurance reimbursement

High Charge Amount

Amount of the most recent DRG high charge outlier in the current contract document; i.e., the point at which additional payment due to high cost of care is allowed

Indirect Medical Ed./Education

Reimbursement for Indirect Medical Education costs

Low Trim Days

Day the account is eligible for the outlier

No.

Sequential reference number of the item

Standard Days

National average length of stay for patients with this DRG

Updated

Date, time and user information of when the lookup table was last updated

Weight

DRG weight factor, established by Medicare for each DRG

APC Tables

Allowance

The allowable payment amount, determined by multiplying the relative weight times the conversion factor

APC Code

Ambulatory Payment Classification code

APC Code From

The beginning Ambulatory Payment Classification (APC) code in a range of APC codes

APC Code To

The ending Ambulatory Payment Classification (APC) code in a range of APC codes

Conversion Factor

The conversion factor multiplied times the relative weight to convert the relative weight into the allowable payment amount

Edit

Link for editing an item

Group Title

Name of the table that contains the listed APC code

Relative Weight

Indicates the resource requirements of the service and is based on the median cost of services in that APC, using APC 603 as the base. Relative weight is multiplied by the conversion factor to determine the allowable payment.

Updated

Date, time and user information of when the lookup table was last updated