client co-pay and fee display at check-in webinar april 28, 2010 presented by thayne parker,...
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Client Co-pay and Fee Display at Check-inWebinar April 28, 2010
Presented By
Thayne Parker, Accounts Receivable Manager Tom Paquette, Senior Data Analyst / Programmer
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Overview
Business Goals:
Accurate display of Private Pay Fee (including discount, if any) or Co-pay (depending on the client’s fund source)
Clearly defined and consistent check-in and collection process
Accurate co-pays and fees, charging all payers consistently-compliance
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Next Steps
Policy for Collections and Fee Determination Expectations Delineate responsibility
Design Computer Solution New process for assigning insurance co-pays New components in CMHC to allow insurance co-pays to be
entered and clearly viewed by staff
Implementation Training Communication Review, Revise, Improve
Define Business Goals
Obtain Executive Support
Identify Solution
Review, Revise, Improve Process
Clarify Expectations
Design Program
Train, Communicate & Implement
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Develop new CMHC Components
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Co-pay Code Maintenance
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Client Specific Co-pay Assignment
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Eligibility Maintenance
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Eligibility Maintenance
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Display Methodology
Find the LOWEST priority 3rd party fund source that was in effect on date of planned event
Is co-pay code on
fund source blank?
Is co-pay code on
fund source NONE?
DONENo co-pay or private fee
Display ‘No Fee’
Find next lowest priority fund
source that was in
effect on date of planned
event
DONEDisplayCo-pay
fromCo-pay table
NO
YES
YES
YES
A potential co-pay situation exists
Was planned service & duration
covered on date of service?
NO
If neither of the DONE boxes are hit from the 1st
process, then continue below to calculate thePRIVATE PAY FEE
Find the private pay record in effect at the time of the
planned service
Is there a level
specified?
Find fee that corresponds to the service that was in
effect at time of planned service
DONEDisplay
Private Pay Fee
DONEDisplay
Private Pay Fee
Is there a standard
fee?
NO
YES
NODONEDisplay‘No Fee’
YESDONE
Calculate fee using discount
percentage in effect at
time of planned event
Is there a fixed fee per visit?
NO
YES
2nd ProcessPrivate Pay Fee
1st ProcessCo-pay
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mtSchedule Display
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Check-in Display
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Lessons Learned
Review the set-up in CMHC for all Fund Sources not just Private Pay
Set up Private Pay Fund Source with it’s own Rate Table If Co-pay code not set up for client – will revert to private
pay discount or fee Co-pay displayed is an ‘estimate’ – actual charge billed to
client’s account is based on response from payer Create edit tools to identify clients with no co-pay code Encourage communication to identify clients with an
incorrect fee displaying
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Recap
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Planning and Implementation
Implementation
Planning
Design
• Define Business Goals• Gain Support • Document the Process & Expectations• Design CMHC Specifications
• Research each fund source• Prepare detailed document outlining
covered services and co-pay amount • Develop plan to train & communicate
• Add co-pay tables • Update client eligibility records• Train• Communicate• Test, measure, adjust & refine
as necessary
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Client Co-pay and Fee Display
Questions and Answers