Encounter Level Sliding Fee Scenarios
You can set up the sliding fee schedule details using the parameters on the Sliding Fee Schedule Detail Maintenance window.
A patient with a family size of one and an annual income of $20000 has a sliding fee attached to an encounter on the Encounter Maintenance window.
The following table lists the encounter-level sliding fee scenarios, and their calculations.
| Level | Schedule Fee Mode | Sliding Fee Mode | Min / Flat Rate Value Mode | Calculations |
|---|---|---|---|---|
| Encounter | Line Item-based | Minimum Value | By Family Size | The patient’s family size of one and an annual income of $20000 allows a 50% discount. A separate adjustment is made for each service line, and it gets adjusted by 50%. The application adjusts the balance on each charge to equal it to the minimum value resulting in a minimum amount of $20 to be paid by the patient. For more information, see Sliding Fee Calculations for Encounter Level Line Item Based Scenarios. |
| Encounter | Line Item-based | Minimum Value | By Percent/Flat Rate | The patient’s family size of one and an annual income of $20000 allows a 50% discount. A separate adjustment is made for each service line, and it gets adjusted by 50%. The system adjusts the balance on each charge to equal it to the minimum value resulting in a minimum amount of $20 to be paid by the patient. For more information, see Sliding Fee Calculations for Encounter Level Line Item Based Scenarios. |
| Encounter | Line Item-based | Flat Rate Mode | By Family Size | The patient’s family size of one and an annual income of $20000 allows a 50% discount. However, since a flat rate of $10 is defined in the sliding fee schedule, this overrides the 50% discount. The system applies the flat rate of $10 to each service line resulting in a estimated patient amount of $20. For more information, see Sliding Fee Calculations for Encounter Level Line Item Based Scenarios. |
| Encounter | Line Item-based | Flat Rate Mode | By Percent/Flat Rate | The patient’s family size of one and annual income of $20000 allows a 50% discount. However, since a flat rate of $10 is defined in the sliding fee schedule, this overrides the 50% discount. The application applies the flat rate of $10 to each service line resulting in an estimated patient amount of $20. For more information, see Sliding Fee Calculations for Encounter Level Line Item Based Scenarios. |
| Encounter | Encounter-based | Minimum Value Mode | By Family Size | The patient’s family size of one and annual income of $20000 allows a 50% discount. A single adjustment takes place and all service lines get adjusted by 50%. This results in a total patient amount of $200 and a minimum amount of $20 to be paid by the patient. For more information, see Sliding Fee Calculations for Encounter Level Encounter Based Scenarios. |
| Encounter | Encounter-based | Minimum Value Mode | By Percent/Flat Rate | The patient’s family size of one and annual income of $20000 allows a 50% discount. A single adjustment takes place and all service lines get adjusted by 50%. This results in a total patient amount of $200 and a minimum amount of $20 to be paid by the patient. For more information, see Sliding Fee Calculations for Encounter Level Encounter Based Scenarios. |
| Encounter | Encounter-based | Flat Rate Mode | By Family Size | The patient’s family size of one and an annual income of $20000 allows a 50% discount. A single adjustment is made and all the service lines get adjusted by 50%. However, since a $10.00 flat rate is specified in the sliding fee schedule, the 50% adjustment rate gets ignored, and the application ensures that the flat rate of $10.00 gets applied to the adjustment amounts and the balance on the estimation is equal to the flat rate. For more information, see Sliding Fee Calculations for Encounter Level Encounter Based Scenarios. |
| Encounter | Encounter-based | Flat Rate Mode | By Percent/Flat Rate | The patient’s family size of one and an annual income of $20000 allows a 50% discount. However, since a $10.00 flat rate is specified in the sliding fee schedule, the 50% adjustment rate gets ignored, and the application ensures that the flat rate of $10.00 gets applied to the adjustment amounts and the balance on the estimation is equal to the flat rate. For more information, see Sliding Fee Calculations for Encounter Level Encounter Based Scenarios. |