Expected Reimbursement Setup

To track Accounts Receivable by expected payment rather than by charges, an expected reimbursement schedule must be associated with each payer. The expected reimbursement schedule should be based upon contractual agreements or the payer's published payment amounts. Often, one expected reimbursement schedule may be used for many payers.

Creating an Expected Reimbursement Schedule

Use the following procedure to create an expected reimbursement schedule and apply it to the payer.

Note: You should be familiar with the information in Charges and Expected Reimbursement before proceeding.

  1. From the Billing menu, select Expected Reimbursement. The Expected Reimbursement Schedules dialog displays.
  2. Click New Schedule, then enter the new schedule name and effective date.
  1. Enter all of the allowed charge codes and the expected reimbursement for each code.

Copying an Existing Fee Schedule or Allowed Reimbursement Schedule

When creating a new expected reimbursement schedule, it is generally easier to copy an existing Fee Schedule or Allowed Reimbursement Schedule, then edit the allowed reimbursement amounts. Use the following procedure to do so.

  1. Click Copy and select whether to copy from the fee schedule or expected reimbursement schedule.
  2. Enter a new name for the schedule being created.
  1. After the fee schedule has been copied, you will edit the allowed reimbursement amounts to reflect the allowed reimbursement:
  1. You may apply the Expected Reimbursement Schedule to any insurance plan by selecting the desired payer check boxes.

To track accounts receivable by allowed reimbursement, a reimbursement schedule must be associated with each payer. The preferred method is to associate an allowed reimbursement schedule with multiple payers in one step from the Allowed Reimbursement Editor.

You may associate Payers with Expected Reimbursement Schedules one at a time from the Payer Editor as illustrated below:

  1. From the Edit menu, select Payers, clicking F11, or clicking . The Edit Payers dialog displays.
  2. Click the Payer arrow to display a list of payers.
  3. Select the Fee Schedule tab.
  4. Click the Fee Schedule Name arrow to display a list of fee schedules from which to choose.
  5. Click the Calculate Expected Using arrow to display a list of reimbursement schedules from which to choose.

Per Diem or Per Visit Flat Rate

Some payers have set maximum payments by visit or by date of service. In these instances, select Flat rate: Per Diem or Per Visitt and enter the rate amount per the payer's contract. An example of a Payment Per Visit Rate follows:

When a reimbursement rate is set on a per visit or per date of service basis, that will be the figure used in Expected Accounts Receivable reporting.

Per Visit Rate

If the payer has a maximum Per Visit Rate, select Expected Payment Per Visit and enter the rate.

Note: For purposes of tracking underpayment or over payment, based on expected payment per visit or per day, the system will spread the reimbursement pro-rata across the charges for the visit or date of service. For example, if the payer had a $50 allowed reimbursement per visit, and charges for the visit totaled $100, the system would automatically pro-rate the allowed reimbursement for each charge at 50% of the charge amount as illustrated.

Procedure Charge from Fee Schedule

Calculated Allowed Reimbursement

97110 $25 $12.50
97530 $30 $15.00
97001 $45 $22.50
Total $100 $50.00

Expected Reimbursements Change Log

Insight now provides a change log that tracks the clinic's expected reimbursement schedules. You can use the change log to identify when an expected reimbursement schedule changes and who initiated the change. In addition, a record of the initial reimbursement schedule is provided. This change log is intended to provide you with information about expected reimbursement schedules that have changed and by whom.

To access the Expected Reimbursement Schedule Change Log, perform the following steps.

  1. From the Billing menu, select Expected Reimbursement. The Expected Reimbursement Schedules dialog displays.
  2. Click Change Log. The Expected Reimbursement Schedule Change Log dialog displays.
  3. Select the Expected Reimbursement Schedules tab to view changes made to the Expected Reimbursement Schedule settings.

    The following table defines the fields contained in the Expected Reimbursement Schedules tab.
Field Description
Fee Schedule The name of the fee schedule.
Field The names of the fields associated with a fee schedule.
OldValue The initial value of the field. Information shows in this field when a field value has changed.
NewValue The current value of the field
User The person who entered the initial or changed value.
Modified The date that the change was made.
  1. Select the Expected Reimbursement Schedule Versions tab to view changes made to the Expected Reimbursement Schedule Version settings.

    The following table defines the fields contained in the Expected Reimbursement Schedule Versions tab.
Field Description
Fee Schedule The name of the fee schedule.
Field The names of the fields associated with a fee schedule.
OldValue The initial value of the field. Information shows in this field when a field value has changed.
NewValue The current value of the field
User The person who entered the initial or changed value.
Modified The date that the change was made.
  1. Select the Codes tab to view changes made to the Codes settings.

    The following table defines the fields contained in the Codes tab.
Field Description
Allowed Schedule The name of the fee schedule.
Effective Date The date that the expected reimbursement schedule becomes effective.
Billing Code A List of the expected reimbursement schedule billing codes.
Field The names of the fields associated with a fee schedule.
OldValue The initial value of the field. Informatino shows in this field only when a field value has changed.
NewValue The current value of the field.
User The person who entered the initial or changed value.
Modified The date that the change was made.
  1. Select the Codes by Range tab to view changes made to the Codes by Ranges settings.

    The following table defines the fields contained in the Codes by Range tab.
Field Description
Allowed Schedule The name of the fee schedule.
Effective Date The date that the expected reimbursement schedule becomes effective.
Billing Code A list of the expected reimbursement schedule billing codes.
Field The names of the fields associated with a fee schedule.
OldValue The initial value of the field. Information shows in this field only when a field value has changed.
NewValue The current value of the field.
User The person who entered the initial or changed value.
Modified The date that the change was made.
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