Encounter-Based and Line Item-Based Sliding Fees

In some cost estimation situations, a line-item based sliding fee adjustment can produce dramatically different estimated amounts for a patient or person than an encounter-based sliding fee adjustment as shown in the following examples.

For example:

• If you apply a line-item based sliding fee adjustment with a minimum payment of $50 and a 90% discount to a patient or person encounter with estimated amounts of $150, $40, and $10, the adjustment applies the minimum payment to each estimated amount resulting in a total estimated amount of $150 to the patient or person.
  Note: When an adjustment results in an estimated amount that is less than the minimum payment, as in this example, the system overrides the adjustment and applies the minimum fees. The estimated amount cannot be less than the adjustment's minimum payment.
• If you apply an encounter-based sliding fee adjustment with the same discount and minimum payment to the encounter, the schedule takes the total of the estimated amount ($200), applies the discount and minimum payment, and arrives at a total charge to the patient of $50.