This lesson teaches you how to use the Care Calculator for insurance patients. The Care Calculator takes the patient's primary care plan and creates a financial responsibility form to help you explain their payment options. This aids you in explaining cost of care and shows the advantages of using the DMPO.
DMPO = Discount Medical Plan Organization
Creating the Insurance Plan Defaults
Care plans for insurance use specifics on allowed CPT codes and the allowed amounts for those codes. This means that each carrier has its own default care plan.
Care Calculator setup takes time but having good default care plans makes creating care plans for patients quick and easy.
EOB Settings
The Care Calculator uses each carrier's Allowed amount to calculate insurance financial responsibility. The recommended ways to find the correct allowed amounts are:
- Enter amounts shown on the contract with the carrier.
- Auto-populate from History. This function creates an allowed amount based on the average amounts paid by that provider over the past 3 months, as determined by EOB/ERNs entered.
Each patient's Care Calculator uses the default information from the EOB Settings and Insurance Bible tabs for their carrier.
Modify the Global Insurance Bible Template
Creating Patient Care Calculators
The first step in creating a patient's Care Calculator is updating their insurance coverage details. From the patient menu under edit information and insurance tab. The insurance tab has the patient Insurance Information and a Coverage tab.
On the right hand side you will want to include the CPT code level details while on this screen.
If you're calling the carrier to confirm the patient's coverage, open the Coverage Details Tab to access all of the information in one place.
When the patient's insurance information is entered, it's time to create the Care Calculator.
The Care Calculator with an active treatment plan or care plan
The Care Calculator with NO active treatment plan or care plan
You can access the Care Calculator from the menu then Care Calculator button and from the Edit Information in the Case tab.
1. Visits - The Total Visits comes directly from the Care Plan chosen.
2. Services - Shows all the Services that comes directly from the Care Plan chosen.
3. Products - Products are separated out from the Services.
4. Total Patient Responsibility - Shows the total that the patient is responsible for using the standard Cash fees.
5. Will show your DMPO name - Shows the total the patient is responsible for using your DMPO.
6. Show Detail - Breaks down what Services and Products will be given to the patient each visit.
How the Care Calculator Calculates Document:
You can break down the Visit Total by clicking the + next to the Visit No.
Red = Excluded from APEX Cap Rate or Excluded from APEX
Green = APEX Discount
Black = APEX fee equals Unit price
1. Save - Any changes made have to be saved as this does not save automatically from this screen.
2. Insurance Coverage - Shortcut for a quick view of their Insurance Coverage details.
3. Refresh Pricing - Any price changes made to the Cash or DMPO fee schedule would be refreshed using this button.
4. View Care Plan - This screen will allow you to make changes to the Care Plan by changing the frequency, adding or removing items, changing units or when and where services or products are given in the Detail Tab.
You can click on Utilities which brings up options to Clear All, Delete, Select Template (to add a new or change existing one) and Save as Template. (if you manually created one)
5. Fin. Resp.
When the forms are created, select each tab and click the button to Print, Email or Send to FileVault the Financial Responsibility forms. If you choose to email the form, a box pops up for you to add the email address.
6. GFE - Good Faith Estimate
Alternative Treatment Plan and Care Plan
Once you have the new Secondary tab, you can click the View Care Plan and make your adjustments to the patients needs.
