Payment Calculator/Cost Estimator

In order to utilize the cost estimator, you will first need to customize some of your settings. 

1. MSRR: 

By clicking on the clinic logo in the upper left corner > Practice > General Info you will be able to choose the Multiple Surgery Reduction Rule (MSRR) for the practice. By default, Medicare will be selected but you can change it to Commercial if need be.

All insurance companies in the public database will use the practice settings for the MSRR.

If you have a specific insurance company that is different you can go to Practice > Insurance Companies to update your private insurance list to override this for that specific insurance company.

Filter by private insurance list, select payer, and choose your multiple surgery reduction rule that you would like to use to override the practice settings.  

2. Fee Schedules

Once an allowed amount fee schedule has been uploaded (the amount contracted between you and the insurance company on how much they will pay you for different CPT codes), click on "Select Insurances" on the ride side to pick the payers that will use this fee schedule as the contracted amount. Selecting this fee schedule for this payer, means that when you go to use the cost estimator, this is the fee schedule that will pull for the contracted amount column.

3. Patient Insurance Eligibility & Benefits

Next, you will need to populate the patient's insurance benefits.  Go to the patient's chart > click insurance profile > make sure the patient's eligibility check is approved (green check mark) >  click on the Elg/Benefits tab. 

Then click "Add New" on the far right, and either use the drop downs which will populate information from the eligibility report, or you can manually key in the amounts.

Once this has been added and saved in the patient's account, you are now ready to use the Cost Estimator.

There should always be an Out of Pocket Remaining listed even if the eligibility report doesn't list it.  

4. Cost Estimator

From the schedule, if you right click on the patient's appointment, you will see a tab that says cost estimator.

Click edit in the upper right-hand corner to add/edit procedure codes. The codes will come over from the EHR in real time. The provider does not need to sign off on the progress note to see the codes.

The fee schedule will be based on the billing configurations. If you need to choose a different fee schedule choose from the drop-down. 

Click calculate in the bottom right corner to see the total amount the patient will owe.

Please Note: The cost estimator only takes into account the patient's primary insurance.

Tips:

The Payment Calculator/Cost Estimator can be used:

A. Before an appointment to calculate how much a procedure or office visit would cost a patient

and

B. After an appointment to calculate how much money the patient owes based on the codes generated in the back and the patient's insurance benefits

It's important to set up three things before using the Payment Calculator/Cost Estimator:

1. The Multiple Surgery Reduction Rule (MSRR) 

2. Your office's contracted fee schedules 

3. The patient's benefits