Expected Reimbursement

Expected Reimbursement Schedules are required for all payers in Insight Billing. Since most payers do not pay your full fee schedule, running Accounts Receivable reports using Expected (or Allowed) Reimbursement provides you with a much more accurate estimation of expected cash flow. The following example shows total accounts receivable based on the fee schedule.

This shows the same accounts receivable based on allowed reimbursement.

Adding an Expected Reimbursement Schedule

From the Billing menu, select Expected Reimbursement. The Expected Reimbursement Schedules dialog displays.

  1. Click New Schedule.
  1. Enter a unique name for your new expected reimbursement schedule a unique name in the Name field.
  2. Enter the date that this schedule will be effective in the Effective Date field.
  3. Click Save to save your changes and return to the Expected Reimbursement Schedules dialog.

Note: When an expected reimbursement amount is added or updated, all existing charges that exist for visits on or after the effective date will be updated to reflect the new amount.

Adding Allowed Reimbursement Amounts

  1. Click Add.
  2. In the new row, click the Charge Code field and then click the arrow to display a list of charge codes.
  3. Select a charge code from the list.
  4. Enter the expected reimbursement in the Expected Reimbursement field.

Associating Allowed Reimbursement with Payers

Select payers to use the selected allowed reimbursement schedule, as illustrated.

Flat Rate Reimbursement Schedules

Some payers pay a maximum per diem or visit rate, regardless of the services provided. In those instances, enter the per diem or per visit rate in the Fee Schedule tab of the Edit Payer screen.

In the example here the payer will pay a flat rate of $75 per visit.

Medicare RVU/Locality/MPPR

The Medicare MPPR Program decreases payment for the Practice Expense RVU when multiple procedures are performed on the same date of service for all therapy providers operating under the same NPI. The MPPR that applies to the practice expense was increased to 50% for all outpatient therapy settings and an additional 1.6% Sequestration Cut of the total allowed payment after the allowable fee is calculated and the MPPR reduction is taken into account.

In the Calculate Expected Using field, select Medicare RVU/Locality/MPPR to use this calculation for expected reimbursement.

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