Prorating Charge Balances using Balance Control
You can prorate the charge balances on an encounter between the primary and secondary insurances, or between the primary insurance and patient if no secondary insurance exists. The prorated amount is based on the fee for service allowed amount and reimbursed % defined in the fee schedule for the contract linked to the primary payer.
The prorate functionality works only if the Prorate Insurance Balance check box is selected in the following areas in File Maintenance:
- tab
- tab, Libraries sub-tab
Example:
A contract is set up for Medicare with fee schedule parameters as follows:
| CPT Code | Charge Amount | Allowed Amount | Reimbursed % |
|---|---|---|---|
| 99213 | $100.00 | $90.00 | 80% |
| 81002 | $35.00 | $20.00 | 80% |
| 82962 | $35.00 | $20.00 | 80% |
When you enter the above charges on an encounter where Medicare is the primary payer, the charges balances are automatically prorated so that 20% of the Allowed Amount moves to the Ins2 Amt bucket in Balance Control.
If there is no secondary insurance on the encounter, the charges balances are automatically prorated so that 20% of the Allowed Amount moves to the Pat Amt bucket in Balance Control.
If secondary insurance is later added to the encounter, you can select the Prorate button to move the prorated 20% of the Allowed Amount from the Pat Amt bucket to the Ins2 Amt bucket.