Processing Self-Pay Patients

There are two options for how your office can process self-pay patients (patients without insurance).

Option 1: Use a Self-Pay Fee Schedule

1. Under Practice > Practice Fee Schedules, add a fee schedule for your self-pay rates. ex. CPT 11100 is $80.
2. Under the provider's Billing Configurations, click on Add New Configuration to add a Self-Pay configuration (check off "Self-Pay" and select your self-pay fee schedule).
3. When no insurance information is added to a patient's Insurance Profile, that patient will be marked self-pay by default.
4. The front desk can use the Cost Estimator (right-click on an appointment from the Schedule) to see how much money they should collect from the patient based on the procedures done in during the office visit.
5. The front desk adds the payment to the patient's Financials and links it to the Appointment.
6. When the provider signs the note, the Encounter comes into the practice management system. Because there is no Insurance Profile for the patient, the Insurance Profile is set to Self-Pay by default and the Self-Pay billing configuration kicks in. This means the responsibility defaults to the patient right away when the Encounter is posted.
7. The biller goes into the patient's Financials and applies the patient payment collected by the front desk, thus bringing the balance down to $0. With a $0 balance, the "claim" is automatically marked completed.

Option 2: Use items

1. Under the Billing Settings, add an item for each CPT code. ex. Self-Pay Biopsy is $80.
2. The provider can create a treatment plan so that in lieu of 11100, the system pulls an item or suggests the item(s) when the treatment plan is selected. See this article for more information on this.
3. If the provider does not link items to the treatment plans, the Billing Note field can be used by the clinical staff to inform the front desk staff which items they should add to the patient's Financials.
4. The front desk collects payment from the patient and applies the payment to the item. The balance of those items should now be $0 to show the patient paid in full on the date of service.
5. The provider or clinical staff marks the encounter Non-Billable.