Financial Arrangements/Fee Schedules

Transcription

1 it just makes sense

2 Summary This Feature Summary will be divided into four sections, Financial Arrangements Fee Schedules Financial Arrangement Document Template Financial Arrangement Questionnaires Each section details an important part of creating a complete Financial Arrangement for your patient. Financial Arrangements There are two ways to complete a Financial Arrangement. The first one is to manually enter in all of the charges and discounts, along with the respective amounts. The second one is to use specific fee schedules that will auto populate the fields with default information. If it is the protocol at your practice to charge various fees for service, or give several types of discounts, you may prefer to create a manual Financial Arrangement for your patients. The first step should be to create a Financial Arrangement type in order to give your Financial Arrangement(s) parameters that your office requires. Create a Financial Arrangement Type 1. From the Edit menu, click Setup icon. 2. Select Financial Arrangement Type item. 3. Click Add button. Description The name of the Financial Arrangement Type. Default Down Payment Standard down payment from the patient. Low Down Payment The amount that is the lowest acceptable down payment. If an amount is entered in the Financial Arrangement that is lower than what is specified in the Low Down Payment field, you will receive a warning. Until Contract Start The number of months/days/weeks until the contract will start. Revised

3 Max Days Until Signature When a Financial Arrangement is created, how many days expected until it is signed. High Payment Number The maximum number of payments allowable. Days Until Signature Expires The number of days elapsed before a Financial Arrangement signature expires. Document The default document for merging. Frequency The frequency of the charges. Fill in the appropriate information, click OK button. Create a Financial Arrangement 1. From the Home menu, click Edit Patient icon. 2. Click Relationship tab to verify the correct responsible party information. 3. Click Insurance tab to verify the correct subscriber and policy. 4. Click Ledger icon. 5. Click Financial Arrangement icon. 6. Click Add button. There are five sections to a Financial Arrangement Orthodontic Financial Arrangement Patient Payment Arrangement Details Patient Payment Information Contract Signature Revised

4 Orthodontic Financial Arrangement Section The Orthodontic Financial Arrangement section is where you can add a service or discount, or remove an unnecessary one. Give the arrangement a description in case you need several. Print Print the Financial Arrangement. the Financial Arrangement. Rebuild Any changes made to the Financial Arrangement will be discarded. Service The Charge transaction type to select from to add an item or service to the Financial Arrangement. Disc The Discount transaction type to select from to apply a discount to the Financial Arrangement. Remove Remove a selected item or service from the Financial Arrangement. Merge Merge the Financial Arrangement with the selected Document Template. Status The status of the Financial Arrangement. Description The name of the Financial Arrangement. Type The description and details of the Financial Arrangement. Responsible The patient s Responsible Party. Document The Document Template selected to merge with the Financial Arrangement. Add a Service or Discount 1. Enter a Description name and verify the Responsible field. Select a Document for Merging. Financial Arrangement documents are discussed in Section Click the Type field and select the Financial Arrangement Type. 3. Click the Service button. 4. Select the desired Code/Description from the available transactions, click OK button. Revised

5 5. Click in the Contracted Amount column and enter the amount. 6. If the patient has insurance, click in the listed name Insurance column and enter the primary benefit amount. Notice the Patient Share has decreased. If the patient has secondary insurance, click in that column and add in the amount. 7. Continue to add services a required, filling in the appropriate amounts. This can also be used to add services such as Records or X-rays with a $0.00 amount as part of the Orthodontic Financial Arrangement. 8. If the patient is eligible for a discount, click the Disc button. From the list of discounts, select the appropriate one. The Discounts appear in a separate table. 9. In the Contracted Amount column, enter in the allowable discount. Patient Payment Arrangement Details Section This section determines the payment arrangements for the patient. You can use the slider to determine payments or simply type in the number that the patient is comfortable with to see the numbers. The Net Patient Share matches the Patient Shore in the Orthodontic Financial Arrangement section. Net Patient Share The amount the patient is expected to pay. Revised

6 Patient Down Payment Determine the amount the patient will pay to have the braces on. Recurring Payment Balance The remaining amount the patient is expected to pay AFTER the down payment has been entered. Interest Rate The interest rate charged if the office is to carry the loan. Frequency The payment structure. Total # of Payments Number of payments the patient will pay. Recurring Payment Amount The dollar value of each payment. Date of First Payment The date the first payment is due. Date of Last Payment The date the last payment is due. 1. In the Patient Down Payment field, slide or the in the amount. 2. In the Total # of Payments field, slide or type in the number of payments. The Date of First Payment and Date of Last Payment are calculated according to the Frequency of payments selected. The default is Monthly. 3. In the Date of First Payment field, type the date according to the office protocol. Patient Payment Information Section If the patient elects to have the payments automatically deducted from their checking account, or charged to their credit card, the information can be entered here. Enable Autopays Check if the patient agrees to have payments deducted automatically from their checking account or charged to their credit card. Last 4 of Card The last four digits of the charged credit card are displayed. Card Type Automatically fills in based upon the credit card number that was entered. 1. Check the Enable Autopays box. If enrolled with OpenEdge (XWeb) select the appropriate information. 2. The Patient Payment Information will look similar to the following figure. Revised

7 Contract Section If a Financial Arrangement document template has been created this is where you can merge the agreed upon amounts into a Truth in Lending document that the patient can sign in the Signature section, or if you have Topaz, sign with the signature pad. How to create a Financial Arrangement Document Template is explained in Section Verify the correct document is selected in the Document field at the top of the Orthodontic Financial Arrangement section. 2. Click Merge button. Using the scroll bar at the right, scroll down to see the document merged with the financial arrangements at the top. NOTE: At this point the document cannot be modified from preview as in the Letter Queue. You would need to add/modify information in the Financial Arrangement and remerge the document for the correct figures to display. Signature Section If the document is correct, it is now time for the signature. Scroll down far enough to see the signature section. A Signature Merge field has been added to the document for easy merging into the letter. 1. Click Capture button. Have the Responsible Party draw their signature in the box. Revised

8 2. Click OK button. 3. Click Merge button to add the signature to the document. The following prompt appears. 4. Click OK button. This will lock the Financial Arrangement with the current values and settings. The Responsible Party s signature has been added to the document. NOTE: Financial Arrangement documents, once merged CAN NOT be edited. Revised

9 Unlock and Unsign a Financial Arrangement There may be times when you need to unlock a Financial Arrangement for modifications even after it is signed. It takes specific permissions to Unsign it. At the top of the Financial Arrangement there will be an Unsign button if you have the permission to perform this task. 1. From the Edit menu, click Setup icon. 2. Click Employees item. 3. Check the Unsign Financial Arrangements permission. Unlock Financial Agreement 1. Click Unsign button. The following prompt appears. 2. Click OK button. The signature is removed from the Financial Arrangement. The Arrangement can now be modified. Revised

10 Re-merge a Financial Arrangement 1. Modify the fields as necessary. 2. Click Merge button. The new information is reflected. 3. Have the Responsible Party sign the Financial Arrangement document again. Using Rebuild The Rebuild button gives you the option of adding services or discounts to a Financial Arrangement. Once you add a service or discount, click on Rebuild button. The changes will be discarded and the Financial Arrangement will go back to the state before you added the changes. NOTES: Each time a Financial Arrangement is merged with a document, the document is stored in the patient s Document Cabinet. Each time a Financial Arrangement is signed or unsigned, it will be in the patient s History tab indicating if there were issues with the document, (such as if the patient already had an active contract) and the individual who made the changes. Fee Schedules If you office is under contract with multiple insurance plans, a Fee Schedule that is specific to that plan can save time and improve accuracy over researching and inputting this information manually. You can create as many fee schedules as necessary for your office and assign them to an Employer, a Responsible Party, a Doctor, a Location or even a Practice. Once assigned the amounts listed will populate a Financial Arrangement for viewing and acceptance. The first step would be to create a Fee Schedule Type. Create a Fee Schedule Type 1. From the Edit menu, click Setup icon. Revised

11 2. Click Fee Schedule Types item. 3. Click Add icon. Description The name of the fee schedule type. Code The unique identifier of the fee schedule type. Is UCR Check this box if the fee schedule type should use the Usual, Customary or Reasonable amounts. When checked, the balance of the check boxes cannot be selected. When creating the fee schedule, the only columns available for fee entry will be the UCR column. This Fee Schedule type is typically assigned to a Responsible Party that does not have insurance benefits. Default to UCR Check this box to indicate the fee schedule should default to the UCR fees. When checked, you have additional check options available. If checked, this column displays for fee entry on the fee schedule. Use Chargeable Amount Check this box to indicate the fee schedule should use the chargeable amount on the fee schedule. When checked, additional check options are available. If checked, this column displays for fee entry on the fee schedule. Use Patient Copay Check this box to indicate the fee schedule should use the patient copay on the fee schedule. When checked, additional check options are available. If checked, this column displays for fee entry on the fee schedule. NOTE: If the Use Patient Copay box is checked on the Fee Schedule Type, any amounts entered will not display in a column on the Financial Arrangement. There is NOT a column for Copay amounts. The amounts will however, be added to the Patient Share amount. Revised

12 Create a Fee Schedule Fee schedules can be assigned at many levels, i.e., Responsible Party, Doctor, Location and/or Practice. When creating a Fee Schedule, you must decide which level you are going to create it for. An insurance company may provide you with amounts that it expects you to charge your patient. This would be an Insurance Fee Schedule that might be assigned to the Policy. If your practice has specific amounts to charge a patient, it would be a Practice Fee Schedule. Below are some examples of Fee Schedule Types. Having all types of fee schedules created allows any type to be applied. 4. Enter a Description for the Fee Schedule Type. 5. Check the appropriate boxes, click OK button. Fee Schedule Transaction Types Once you have the Fee Schedule Types created, it is time to review Transaction Types. In order for transactions to be added to a fee schedule, they must be setup properly. Currently you have several Is Contract transactions in your database. The way they are currently setup, you will not be able to add them to a fee schedule. They are only available for using in a contract. You will find it necessary to add or modify transactions to be used in a fee schedule. The following example is an Is Contract transaction that is not setup to use in a fee schedule. Revised

13 Contract Transaction Type 1. From the Edit menu, click Setup icon. 2. Click Transaction Types item. Select a current Is Contract transaction. 3. Click Edit icon. This Transaction Type is currently being used to create a contract. The Transaction Codes added automatically place the CDT code in the contract and on the claim form. Revised

14 To be able to add a transaction to a Fee Schedule, specific fields need to be filled in. Look at both the new fields in the Transaction Type screen, along with new tab choices. c c c c Tabs Fee Schedules Charting Checkboxes and Fields Is Contract Default Payments Is Optional for FA Code Fee Schedules Displays the Fee Schedules this Transaction Type belongs to. Charting Options to apply if certain conditions are met on specific teeth. (Used for Pedo) Code If left blank, click the Transaction Codes tab and enter the appropriate CDT code to display on contracts. Is Contract Default Payments: The months of payments are an optional field. If you place a number in this field, it displays on the Financial Arrangement as well as the standard financial contract, but can be modified. Is Optional for FA Once checked this Transaction Type becomes an optional choice in the Financial Arrangement. Revised

15 Create Transaction Type for Fee Schedule 1. From the Edit menu, click Setup icon. 2. Selection Transaction Types item. 3. Click Add icon. In this example, the office is under contract with Delta Dental of TX. Once you add in the Description, add the Code. 4. Click Lookup button. 5. Select the appropriate CDT code and click OK button. Notice the Transaction Codes tab is not selectable, but the Fee Schedules tab is. 6. In the Is Contract checkbox, enter the number of payments usually associated with this transaction. 7. If you want this transaction to be optional for adding to the Financial Arrangement, check the box. You will add this transaction to the correct Fee Schedule(s) after it is created. 8. Click OK button. Revised

16 Create Fee Schedules As stated before, you can have as many fee schedules as necessary to select from. Each insurance company that you are contracted with will have different amounts that they want you to charge the patient. In the example used, the office is under contract with Delta Dental of TX. 1. From the Edit menu, click Setup icon. 2. Select Fee Schedules item. 3. Click Add icon. Name The name of the Fee Schedule. Type The Fee Schedule Type that should be applied. Parent If this Fee Schedule is a subset, or child of another Fee Schedule, select the applicable parent. This fee schedule will be applied first, and then go back to the parent fee schedule for additional transactions. Order The Fee Schedule list order. Filter Select the Location this Fee Schedule should be applied to. The default is ALL Locations. Add Add a transaction to the Fee Schedule Delete Delete a transaction from the Fee Schedule Add All Add all transactions to a Fee Schedule that do not currently exist within. Import Schedule Import fees from another Fee Schedule. In this example, the Type field is Insurance Default & Charge. This means that the Financial Arrangements will use the Chargeable Amount and if a service is added that is Revised

17 NOT on the Fee Schedule, it will look to the Default to UCR Fee Schedule to find and apply the correct charge. 4. Enter in the name desired. 5. From the list, select the Type of Fee Schedule. 6. If this Fee Schedule a subset or child of another Fee Schedule, select the Parent Fee Schedule. 7. In the Order field, enter the number to display in the list. 8. In the Filter field, select the specific location, if applicable. 9. Click the Add button to add in any Transaction Types that belong to this schedule. 10. Enter in the Amounts in the appropriate columns. 11. Click OK button. The following page illustrates how to read this: Revised

18 In the Delta Dental of TX Fee Schedule, the Allowable charge is $4, The contract will reflect the $5, Chargeable amount, as this is what the office usually charges for this treatment. An insurance discount will be given on the Financial Arrangement of $1, This Fee Schedule would be assigned to the Policy, as the patient is a subscriber of this Insurance Plan. The Financial Arrangement first looks at the Transaction Type selected. Since the transaction is listed in the fee schedule that the policyholder subscribes to, the chargeable amount automatically fills in. The appropriate discount transaction has been manually added to the Financial Agreement. Revised

19 If other services need to be added to the Financial Arrangement and they are NOT included in the Fee Schedule that is assigned to the Insurance tab, the Financial Arrangement looks to see if there is a Default Fee Schedule assigned to the Responsible Party. Typically UCR Fee Schedules are assigned to the Responsible Party. choices. Notice that the Is UCR Fee Schedule includes additional items. If these additional items are added to the Financial Arrangement, the Financial Arrangement looks to the Insurance Fee Schedule first, and then goes the UCR Fee Schedule second, as instructed by the above Revised

20 As you can see by the above example, Financial Arrangements can be created with ease and you can be assured that you are using the amounts that have been set forth by the insurance companies. Create an Office Charge Fee Schedule This example of a Fee Schedule is one that uses the current office charges for treatment, not what an insurance company would require to be charged. It contains all of the offered treatment types along with the 3 optional services. NOTE: The Fee Schedule Type selected was Office Charges and it is UCR. The Fee Schedule would be applied to Responsible Parties that do OR do not have insurance. The Responsible Parties that do have insurance are not ones that the practice is currently under contract with. Apply the Fee Schedule to the Responsible Party. This Fee Schedule supplies the amounts that the office normally charges for treatment. Revised

21 Assign a Fee Schedule to an Employer Plan 1. Open the patient. 2. Click the Insurance tab. 3. From the Fee Schedule field, select the applicable Fee Schedule. Assign a Fee Schedule to an Employer Plan Through Setup 1. From the Edit menu, click Setup icon. 2. Click the Employer item. 3. Use the Search field to locate a specific Employer Name. Revised

22 4. Select the Employer and click Edit icon. 5. In the Employer Plans section, click the plan and click Edit button. 6. From the Fee Schedule field, select the applicable Fee Schedule. Assign a Fee Schedule to a Responsible Party 1. Open the patient. 2. Click the Relationship tab. 3. Click the Responsible Party that is the subscriber. 4. From the Fee Schedule field, select the applicable Fee Schedule. Assign a Fee Schedule to a Doctor 1. From the Edit menu, click Setup icon. 2. Click Employees item. 3. Select the Doctor the Fee Schedule will be applied to, click Edit icon. Revised

23 4. Click the Insurance tab. 5. From the Fee Schedule field, select the applicable Fee Schedule. Assign a Fee Schedule to a Location 1. From the Edit menu, click Setup icon. 2. Click Locations item. 3. Select the Location the Fee Schedule will be applied to, click Edit icon. 4. Click Licensing tab if necessary. 5. From the Fee Schedule field, select the applicable Fee Schedule. Revised

24 Assign a Fee Schedule to a Practice 1. From the Edit menu, click Practice Information icon. 2. Click the Insurance tab. 3. From the Fee Schedule field, select the applicable Fee Schedule Import a Fee Schedule If you have created a Fee Schedule that could apply to another one with minor modifications, importing would be a quick and easy way to accomplish this. 1. Create a new Fee Schedule with the desired selections. 2. Click Import Schedule button. A list of existing Fee Schedules is displayed. 3. Select the Fee Schedule from the list, click OK button. The new Fee Schedule now contains the information from the one selected. Financial Arrangement Document Template After presenting the patient s Financial Arrangement, a document should be created for signature. In my first example, a document had been created ready for the Responsible Party to sign. These documents are created in the Document Editor with a few special twists. Revised

25 Open the Document Editor 1. From the Home menu, click Document Editor icon. A blank page appears. Create a New Financial Arrangement Document 1. Click the New icon, and select New Financial Arrangement item. NOTE: This MUST be selected, as an entire list of new merge fields is available. These fields are based on the available fields in the Financial Arrangement. If you do not select New Financial Arrangement, the document will not be available for merging in the Financial Arrangement. The below merge fields are only available if the App Preference for Financial Arrangements has been turned on. 2. From the Mail Merge tab, click Insert icon. You should become familiar with the merge fields that are available from the Financial Arrangement. You can still use the other merge field categories within the Insert list. Here are some merge codes that will make your Financial Arrangement professional. Please note that the text surrounded in blue is static text, or text that has been typed in manually. Revised

26 To have a Services Table from your Financial Arrangement appear in your document like this: Use the Merge Codes: Revised

27 To have the Patient Payment Arrangement Details from the Financial Arrangement to appear in your document like this: Use the Merge Codes: Revised

28 To have the Patient Payment Information from the Financial Arrangement appear in your document like this: Use the Merge Codes: To have a Signature from the Financial Arrangement appear in your document like this: Use the Merge Code: PLEASE NOTE: Financial Arrangement documents, once merged CANNOT be edited. Once you complete your Financial Arrangement document, it is now available to select from the Document field in the patient s Financial Arrangement. Revised

29 Financial Arrangement Questionnaires Using a Questionnaire is an easy and fast way to create a Financial Arrangement however, there is information that needs to be considered and setup first: The trigger to have the Questionnaire populate a Financial Arrangement service is to make sure a procedure is assigned to the answer. A Fee Schedule must be created and applied at the appropriate level (patient, responsible party, employer, etc.). If a service (transaction type) has been marked as Is Contract it cannot be removed from a Financial Arrangement if selected as an answer on a Questionnaire. These services are not required in a Financial Arrangement. Any service (transaction type) that has been marked Is Optional for FA can be removed from the Financial Arrangement. These services are optional when creating a contract such as ceramic brackets. Any service (transaction type) can be marked as BOTH Is Contract and Is Optional for FA. We will look at each one of these points to make sure that your Questionnaires are ready to create a Financial Arrangement from. Create a Financial Arrangement Questionnaire Add an Is Contract Transaction Type Question and Answer 1. From the Edit menu, click Setup icon. 2. Click Questionnaires item. The example is a completed question that uses Is Contract Transaction Types: Question: Treatment that needs to be done: Answers: Comprehensive-Adult Limited Treatment-Adult Comprehensive-Child Limited Treatment-Child Invisalign-Full Adult Phase I Invisalign-Full Child Phase II Revised

30 These items are available to choose from when creating a patient contract. The Is Contract checkbox has been selected. The Code field must be filled in with the appropriate CDT Code in order to be included in a Fee Schedule. The Is Contract is used as the primary treatment of the Financial Arrangement. NOTES: Multiple Is Contract Transaction Types can be selected for a Financial Arrangement. The one with the most payments will be the primary when dealing with defaults. Is Contract Transaction Types are not required in a Financial Arrangement. A procedure can be both marked Is Optional for FA and Is Contract. Adding Answers to Questions Once you add an answer to the question, the Procedure(s) must be added. This is what triggers the service to be included in the Financial Arrangement. Multiple procedures can be added to an answer for inclusion in the Financial Arrangement. Single Procedure Added Multiple Procedures Added Revised

31 3. Click Add button and select the procedure. Repeat as desired to add multiples. 4. Click OK button. Add a Non Is Contract Transaction Type Question and Answer The example figure is a completed question that uses a non Is Contract Transaction Type: Question: Answers: Optional Procedures: Acceledent Ceramic Brackets Bleaching Trays w/kit These items are Optional services for the Financial Arrangement. These services may be removed when it comes time to sign because of a patient s financial limits. As with the Is Contract transaction types, these must have the Code field filled in to be included in a Fee Schedule. Be sure to check the Is Optional for FA checkbox. Revised

32 Once you add an answer to the question, the Procedure must be added. This is what triggers the service to be included in the Financial Arrangement. Run Questionnaire and Create Financial Arrangement 1. From the Home menu, click Edit Patient icon. 2. Open the patient and click the Questionnaire icon. 3. Click <Run New Questionnaire>, select the Financial Arrangement Questionnaire. Revised

33 4. Fill in or select the appropriate answers. Select the procedures to include in the Financial Arrangement, click OK button. Single Procedure Added Multiple Procedures Added 5. Select any Optional Procedures to add to the Financial Arrangement. 6. Click OK button to generate both the Questionnaire and the Financial Arrangement. 7. Click Ledger icon. 8. Click Financial Arrangements icon. 9. Click Add button. Revised

34 Single Procedure Answer Added CV Multiple Procedure Answer Added The services have been added to the Financial Arrangement with the figures inserted from the Fee Schedule. The Acceledent Service has an O in the Status column. This states it is an optional service and can be removed from the Financial Arrangement. The Comprehensive- Adult service cannot be removed from the Financial Arrangement. If there is nothing in the Status column, it has been imported from the questionnaire and is required. If there is a + in the Status column, they have been added manually and can be removed regardless of the setup defaults. In the Contracted Amount Column, put in the amount the patient will be charged. This would be the same as the UCR column. Add any insurance benefits that the patient might have and the Financial Arrangement will reflect the correct Net Patient Share. Remove a Service 1. Check the box to the left of the Optional Service. 2. Click Remove icon. The numbers will be adjusted. Revised