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