Payment Control

Summary

This enhancement to Payment Control introduces several additions to the pre-approved payment workflow, introduced in Feature #27641, that add information and assist with troubleshooting of this workflow.

·         A new "Explanation" workflow assists users in explaining a PreApproved Payment to a patient.

·         A new PreApproved Payment Worklist Flag gives users advanced insight into patients expected to make a PreApproved Payment.

·         Estimated PreApproved Payment display on Review screen during Scheduling, allowing patients to be informed ahead of time.

·         Enhanced Audit History for Payment Details to assist with troubleshooting.

Feature Description

With the introduction of the PreApproved Payment workflow (see feature #27641), staff may be asked to have conversations with patients about money that they've never had before.  Because patients are more likely to agree to a PreApproved Payment when they have a good understanding of why they are being asked to do so, this feature provides the RIS user with configurable explanation, instructions, guidance, or possibly even scripts to assist them in communicating with the patient.

These notes will be configured in a new lookup table and tied to a PreApproved Payment rule via the PreApprovedPaymentRule editor. Because the explanation will vary depending on the specific scenario, a new configuration option has been added in the PreApprovedPaymentRule editor to allow an administrator to associate one or more explanation notes to the rule. 

When a user is viewing Payment Details, any explanatory notes that are associated to the matching PreApproved Payment rule will be displayed on a new Payment Explanation screen that can be opened via a PreApproved Payment Explanation button. 

In addition, informative worklist flags, advanced notice of the estimated PreApproved Payment Amount on the Review tab during scheduling, and more informative audit history will assist in the implementation of the PreApproved Payment feature set.

To assist users and clarify the logic behind payment rules, explanatory text can now be associated with a matching rule.

A new Explanation RIS Lookup Table Editor has been introduced to configure the descriptive text. Initially, this will be used for the pre-approved payment workflow by creating an entry with an Explanation Type of PreApproved Payment. In the future, additional explanation types will be available for other workflows.

Messaging is configured by first defining explanatory text, and then associating those messages with pre-approved payment rules. Relevant messaging will then be available on the Payment Details screen and the Scheduling review screen, for example:

The procedure you are having is not expected to be covered by your insurance.  We ask that you give us permission to charge your credit card for the full cost of the exam after your insurance has processed the claim.  If your insurance does pay a portion of the cost, your card will only be charged for any remaining balance.

A preview of the formatted text is available by selecting Edit in Popup from the context menu. This can be helpful when text includes extended formatting.

The new Explanation Code entries are then associated with pre-approved payment rules via a new Explanation column in the PreApprovedPaymentRule editor.

Clicking on a cell in the Explanation column displays an Edit Explanation dialog, where multiple explanations can be moved to the Assigned grid on the right, and then re-ordered as desired using the up and down arrows.

When Explanation notes configured in the PreApprovedPaymentRule lookup table match the current order (or orders if a payment is being made for multiple orders), a new Explanation button will appear on the Payment Details screen for users with Clinical.PaymentExplanation permission.

Clicking it will open the new Payment Explanation dialog to display relevant messaging. When multiple orders are included in the payment, corresponding entries are identified:

To better identify which orders are expected to have a PreApproved Payment and which already have a PreApproved Payment on file, worklists including Reception and Confirmation will now display two new worklist flags.

The PreApproved Payment Expected flag will display when there is a matching PreApprovedPaymentRule with a Type of either Allowed or Required and the amount that would default for the PreApproved Payment is more than $0.00.

Note the "unchecked" checkbox in the PreApproved Payment Expected flag.

This flag will not be displayed when there is already a PreApproved Payment recorded for the visit, or if the default Time of Service Amount to Collect would cause the default for PreApproved Payment to be $0.00. 

For example, if the Default Time of Service Amount to Collect is 100% of estimated Patient Financial Responsibility and the Default PreApprovedPaymentAmount is ALSO 100% of estimated Patient Financial Responsibility, the expectation is that the patient will satisfy the PreApproved Payment with their time of service payment, so the flag should not display.

The PreApproved Payment On File flag will display whenever there is a PreApproved Payment recorded for the visit.

Note the "checked" checkbox in the PreApproved Payment On File flag.

As with other worklist flags, users can filter on these two new PreApproved Payment values:

These new flags can appear on any worklist that displays flags, such as the Reception and Confirmation worklists.

To facilitate a review of PreApproved Payment details with the patient at the time of scheduling, a message regarding pre-approved payment information is now available on the Review screen, in addition to the estimated patient financial responsibility already displayed on the screen.

The message, as configured via the new PreApprovedPaymentOnReviewScreen RIS System Configuration setting, will appear when the estimated patient responsibility for the order is greater than zero (based on the matching PreApprovedPaymentRule applied to the order).

The text can include extended formatting, such as configuring text to display in a red font color for visibility purposes:

Along with this message, the PreApproved Payment Explanation button will also be visible for users with Clinical.PaymentExplanation permission.

Auditing of pre-approved payment transactions has been improved by adding a new Payment Details audit record that is saved after payment result has been returned from Imagine Pay.

Audit entries are now captured each time ImaginePay is opened from the Payment Details, to clarify regular payments vs pre-approved payments, including before and after values:

·         Payment for Previous Balance

·         Payment for Current DOS

·         Amount to Collect

·         PreApproved Payment Amount

·         Whether No Credit Card is checked

·         Whether No Time of Service is checked.

Configuration Instructions

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

RIS Client

Changes to RIS System Configuration Settings

·         Enable this feature by entering a value for PreApprovedPaymentOnReviewScreen text.

The following related settings were added or updated:

Changes to RIS Access String Settings

·         Grant new permissions as necessary.

The following related settings were added or updated: