Estimated Patient Responsibility
This topic describes how to calculate the total patient responsibility based upon the deductible, coinsurance, and copay information from the patient's account.
The Estimate tab allows you to view and print an estimate of the total patient responsibility for services that have been provided and signed off by the therapist before receiving remittance advice from the primary payer.
The estimated patient responsibility is calculated based on the allowed reimbursement for the payer, the selected date range, coinsurance and copay obligations, and whether or not the deductible has been met.
Note: You must select the Deductible Met? check box when the patient's deductible has been met. The system does not automatically track the remaining deductible. You must also select the Deductible Met? check box when there is no deductible at all, or the estimator will pass the full obligation to the patient.
Any co-payments collected for the visit(s) are deducted from the Estimated Patient Amount. If the deductible has not been met, the Patient is responsible for 100% of the insurance allowed amount.
The Allowed Reimbursement Schedule for an insurance plan is set by individual procedure code or as a per visit amount in Clinicient Billing.
The coinsurance percentage, copay amount, and whether or not the deductible have been met is set up in the insurance information for the patient's case.
Confirm that the following parameters have been set up correctly in the patient's case before viewing or printing the patient responsibility report:
- The desired visit date range
- The coinsurance percentage
- Whether or not the deductible has been met
If the patient's deductible has been met since the patient was registered, select the Deductible Met? check box in the Estimate Parameters without opening the Client Editor dialog.
Estimated Patient Responsibility Report
After confirming that the patient's coinsurance, copay, and deductible information is correct, you may print off the estimated responsibility report.
In this scenario, the patient's annual deductible has been met and the copay for the visit has been paid, but he has a 10% coinsurance. Based upon the allowed reimbursement for the insurance, the system estimates that an additional $1.50 is due.
If the patients deductible had not been met, the entire allowed reimbursement for the patient's insurance, less any copayment, would be due.
Configuring the Patient Responsibility Report
You can configure a custom message on the Estimated Patient responsibility report. From the menu bar, click Settings and then select Clinical Settings. From the Edit Settings dialog that displays, select the Messages tab.
Click one of the following links for more detailed information on use of the Cash Register functionality.