The Provider Specialty Percentage reimbursement tool allows you to select a provider specialty percentage lookup table to use for calculating reimbursement for specific provider types or specialties.
Provider specialty lookup tables are created for a specific code type, either Provider Type or Provider Specialty.
- Provider Type – Defines reimbursement for specific types of providers. For example, the provider type “Certified Clinical Nurse Specialist” might reimburse at a different rate than “Nurse Practitioner.” Provider type reimbursements are calculated as a percentage of the total reimbursement at the point that the reimbursement tool appears in the reimbursement calculation.
- Provider Specialty – Defines reimbursement for specific areas of specialty. For example, “Cardiology” might reimburse at a different percentage than “Cardiac Surgery.” Provider specialty reimbursements are calculated as a percentage of the total reimbursement at the point that the reimbursement tool appears in the reimbursement calculation.
- Selecting a Code Type determines whether the Provider Type or Provider Specialty field is active.
Field DescriptionsThe following table describes the fields on the Provider Specialty Percentage tool.
Field | Description |
Code Type | Determines the type of procedure specialty percentage lookup table you can select, either Provider Type or Provider Specialty |
Provider Specialty | Lets you select a lookup table with reimbursement percentages for specific provider specialties |
Provider Type | Lets you select a lookup table with reimbursement percentages for specific provider types |