Encounter Rate Adjustment Methods

The following methods are available for Encounter Rate Auto-Adjustments:

• 20% to next bucket and FIFO
• 20% to next bucket and weighted
• 20% & adjust first line to ER amount
• FIFO
• Weighted
• Adjust first line item to the ER amount and adjust other lines off
• Adjust line items to $0

The following examples illustrate each Encounter Rate Auto-Adjustment method. The examples use an encounter rate amount of $89.05. The lab code (80069) is never adjusted because it is setup as a carve-out code on the Alt Payer tab for the encounter rate payer.

20% to Next Bucket and FIFO

This method moves 20% of each charge to the next bucket, excluding carve-outs. Adjustments are then applied to each charge using a FIFO distribution until the encounter rate payer balance is equal to the encounter rate amount. If the encounter rate amount exceeds the sum of the original charges, positive adjustments are applied.

If the encounter rate value = $150, the expected results are:

If the encounter rate value = $60.30, the expected results are:

20% to Next Bucket and Weighted

This method moves 20% of each charge to the next bucket, excluding carve-outs. Adjustments are then applied to each charge using a weighted distribution until the encounter rate payer balance is equal to the encounter rate amount.

20% & Adjust First Line to ER Amount

This method moves 20% of each charge to the next bucket, excluding carve-outs. An adjustment is then applied to the first charge to bring its balance to the encounter rate amount. All remaining charges are adjusted to a balance of $0.

FIFO

This method applies adjustments to charges, excluding carve-outs, using a FIFO distribution until the encounter rate payer balance is equal to the encounter rate amount. If the encounter rate amount exceeds the sum of the original charges, a positive adjustment is applied to the first charge.

Weighted

This method applies adjustments to charges, excluding carve-outs, using a weighted distribution until the encounter rate payer balance is equal to the encounter rate amount.

Adjust First Line Item to the ER Amount and Adjust Other Lines Off

This method applies an adjustment to the first charge to bring its balance to the encounter rate amount. All remaining charges, excluding carve-outs, are adjusted to a balance of $0.