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| Field | Description |
|---|---|
Enables you to select a person or patient record.
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Opens the account, patient chart, or patient balance based on your selection. The menu displays the following options:
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| Name | Displays the name of the selected person or patient for whom the cost is estimated. |
| Address | Displays the address of the selected person or patient. |
| Date of Birth | Displays the date of birth of the selected person or patient. |
| Guar Name | Displays the name of the guarantor of the selected person or patient. |
| Address | Displays the address of the guarantor. |
| Relation | Displays the relationship of the guarantor with the selected patient or person. |
| EncNbr and Date | Displays the encounter number and date of the encounter when you estimate patient cost from an encounter. |
| Appt Date | Displays the date of appointment when you estimate patient cost from an appointment. |
| Cost Estimate ID | Displays a unique ID (up to 15 characters) for the cost estimate.
The system automatically generates a new unique cost estimate ID in the following situations:
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| Clear | Clears and resets the patient or guarantor information. |
| Payer Selection | Displays a list of payers. You can select only one payer from the list.
The payer list depends on how the cost estimation is initiated.
The payer can be of different types such as:
When you submit the cost estimation data, the system checks if the payer is associated with the contract or not. |
| Self Pay | You can select self-pay if the person or patient chooses not to use insurance and plans to pay out of pocket or does not have insurance coverage.
When Self-Pay is selected, all services are non-covered by insurance.
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| Provider | Displays the rendering providers involved in the physical examination of the selected person or patient.
The rendering providers that appear in Provider depends on how the cost estimation is initiated.
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| Location | Displays the service location. The service location that appears in Location depends on how the cost estimation is initiated.
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| Service Type | Displays industry service types.
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| Field | Description |
|---|---|
| Svc Item | Displays the list of Service Item Library codes attached to the SIM Library selected in File Maintenance on the basis of payer and location configuration. To find a specific SIM, type a part of the SIM code. SIM codes that match what you entered are displayed. You can also enter a SIM group to enlist frequently used SIM codes for estimating the cost. |
| Located in the Svc Item column, the button enables you to search for a specific service item by SIM code or SIM description. | |
| CPT Code | Displays the CPT® code corresponding to the SIM code that you select in Svc Item. This field cannot be modified. Your system administrator maps every CPT® code to one or more SIM codes. |
| M1 M2 M3 M4 | Determines the modifiers for each service. You can enter up to four modifiers for a service. Each modifier can have one or two alphanumeric characters. If you select a SIM code mapped to a CPT® code with modifiers, the modifiers automatically appear in the appropriate columns. |
| Description | Displays the description of the CPT® code. This field cannot be modified. You can hover over this field to view the complete description. |
| Facility | Indicates one of the following:
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| Unit(s) | Determines the quantity of the service item. The default value is 1 and can be modified. |
| Charge Amt | Displays the charge amount per unit of the service item as configured in the SIM library. The charge amount for a service item is calculated as follows: [charge amount] = [allowed amount] + [adjustment amount] If a charge amount is not found for the SIM code entered, no value appears in the Charge Amt field. |
| Allowed Amt | Displays the maximum amount per unit of the service item paid to the provider. The allowed amount includes both insurance and patient responsibility. The allowed amount is fetched from the contract exception, the contract library, or the last historical transaction. |
| Coins | Displays the co-insurance amount, fixed treatment costs for covered services that the patient must bear after paying the deductible amount. |
| Copay | Displays the co-pay, the fixed dollar amount the patient must pay for each encounter. This amount is predetermined in the co-pay clause of the insurance policy. |
| Deductible | Displays the deductible, the fixed amount a patient must pay each year before the insurance payer begins to cover the costs. After the patient’s deductible is paid, the payer starts to share the cost of the service. If the deductible is more than the maximum amount that is paid to the provider, the cost estimation calculator considers the maximum deductible amount as the allowed amount. |
| Adj Amt | Displays the adjustment amount: the portion of the bill that the provider has agreed not to charge. The adjustment amount is the difference between the charge amount and the allowed amount. |
| Non-Covered | You can select the check box to change the service item to a non-covered charge.
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| Delete | Deletes the selected service line item |
| Estimation Notes | A free-text field where you can enter in the notes for the cost estimation. The notes will be saved when you submit the data. |
| ICD-CM | Displays diagnosis codes assigned for the cost estimation. If you open the Estimate Patient Cost window from an encounter, the diagnosis codes assigned to the encounter are displayed by default. You can add or remove diagnosis codes for the cost estimation. |
| Submit |
When you submit the cost estimation data, the system performs the following:
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| Field | Description |
|---|---|
| Copay | Displays the total co-pay amount applied to the service line items in the cost estimation. |
| Deductible | Displays the total deductible amount applied to the service line items in the cost estimation. |
| Coinsurance | Displays the total coinsurance amount applied to the service line items in the cost estimation. The system calculates as follows: [coinsurance] = [sum of coinsurance percentage applied for service line items] x [ estimated allowed amount].
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| Non-Covered | Displays the total charge amount applied to the non-covered service line items. |
| Total Pat Est Amt | Displays the total amount that the patient must pay (also called patient responsibility). [patient responsibility] = [copay]+[deductible]+[coinsurance]+[non-covered] |
| Estimated Charge | Displays the total charge amount applied to the service line items in the cost estimation. [Estimated Charge] = sum of (charge amount per unit * units specified for each service line item) |
| Estimated Allowed | Displays the total allowed amount applied to the covered service line items in the cost estimation. [Estimated Allowed] = sum of (allowed amount per unit * units specified for each service line item) |
| Estimated Adjustment | Displays the total adjustment amount applied to the covered service line items in the cost estimation. [Estimated Adjustment] = sum of (adjustment amount per unit * units specified for each service line item) |
| Patient Resp Amount | Displays the total amount that the patient must pay for the services added in the cost estimation. |
| Total Ins Est Amt | The total amount that the payer pays for the services used by the person or patient (also called insurance responsibility). [insurance responsibility] = [allowed amount] - [patient responsibility] |
| Percentage to Request | Displays the percentage of patient responsibility amount that the patient agrees to pay in advance.
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| Min Amt to Request | Displays the minimum amount that the patient agrees to pay in advance using the following calculation: [minimum amount to request] = [patient responsibility] x [percentage to request] |
| Patient Agrees to Pay | The fields under the Patient Agrees to Pay section indicate the payment options for the patient. |
| Min Amt | You can select the option if the patient wants to pay the minimum advance amount. |
| Total Pat Est Amt | You can select the option if the patient wants to pay the amount shown in Patient Resp Amount. |
| Other Amt | If the patient wants to pay a custom amount, you can select the option and enter the amount. |
| Field | Description |
|---|---|
| Estimation Date/Time | Displays the date of cost estimation |
| Cost Estimate ID | Displays a unique ID for cost estimation |
| Service Date | Displays the date of service rendered |
| Payer Name/Self Pay | Displays the payer's name or self-pay |
| CPT(s) | Displays CPT®4 codes (separated by commas) selected for cost estimation |
| Estimated Charge | Displays the charge amount projected in the cost estimation |
| Estimated Allowed | Displays the allowed amount projected in the cost estimation |
| Estimated Patient Amount | Displays the amount projected as patient responsibility in the cost estimation |
| Patient Agrees to Pay | Displays the amount that the patient or person agrees to pay in advance |
| Patient Paid Amount | Displays the amount paid by the patient |
| Created By | Displays the name of the staff member who has created the cost estimation |