Payment Control

Summary

This enhancement to PreApproved Payment Rules adds the ability to configure a Preapproved Payment amount based on a percentage of an alternate rate from the National Payer Database. Typically, the alternate rate would be a Self-Pay Rate, but could be a different rate from the National Payer Database, such as the Usual and Customary rate.

This feature is currently only available for customers using Imagine Billing and storing contractual rates in National Payer Database.

Background

The existing PreApproved Payment feature allows the imaging provider to request permission from the patient to charge up to an agreed upon amount after the claim has been adjudicated and the exact amount the patient will owe has been determined.

Previously, it was possible to set a PreApproved Payment amount based on a percentage of the estimated Visit Cost or the estimated Patient Financial Responsibility. However, there are times when a third option is needed.

Feature Description

With this change, the Default Preapproved Payment Amount rule editor in the PreApprovedPaymentRule table has been updated with a new % of Alternate Rate option.

When this new option is selected, the administrator will select the desired alternate rate by entering the code for a valid NPD Insurance Number (typically, this will be the code for the desired Self Pay rate) and indicate what percentage of the alternate rate should be used when calculating the amount to be requested as a PreApproved Payment.

Once configured, when a user clicks Add Payment, the Payment Details will display a PreApproved Payment Amount value based on the configured percentage of the alternate rate cost for the scheduled procedure(s) minus the amount to be collected at time of service (if any).

Configuration Instructions

System Administrators must complete the following actions to enable this feature:

Changes to PreApprovedPaymentRule Lookup Table

To create rules that set a PreApproved Payment based on an alternate rate, configure a rule in the PreApprovedPaymentRule table:

·         Set the Default PreApproved Payment Amount to the % of Alternate Rate option.

·         Enter a valid NPD code in the NPD Insurance Number for alternate rate field.

·         Set the desired percentage.

As with other rules in the PreApprovedPaymentRule table, the administrator can then define the conditions under which the rule should be applied.