Patient and Encounter Level Sliding Fee Scenarios

The following conditions are considered for cost estimation if sliding fee schedules are attached at both patient chart level and encounter level.

If a cost estimation is launched from an encounter which has a sliding fee schedule attached, then the encounter level sliding fee takes precedence over patient chart level sliding fee schedule.
If the cost estimation is launched from a patient appointment, and the appointment has an encounter attached to it, then any sliding fee schedule attached to this encounter takes precedence over a chart level sliding fee schedule.
If a cost estimation is not launched from an encounter or an appointment attached to an encounter, the patient chart level sliding fee schedule takes precedence.

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 using the UDS tab on the Modify Patient Information window.

A different sliding fee schedule is attached at an encounter level on the Encounter Maintenance window.

The following table lists the person and patient level sliding fee scenarios and their calculations.

Level	Schedule Fee Mode	Sliding Fee Mode	Min/Flat Rate Value Mode	Calculations
Patient and Encounter	Line Item-based	Minimum Value	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 minimum value resulting in a minimum amount of $20 to be paid by the patient. For more information, see Sliding Fee Calculations for Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Line Item-based	Minimum Value	By Percent/Flat Rate	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Line Item-based	Flat Rate Mode	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Line Item-based	Flat Rate Mode	By Percent/ Flat Rate	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Encounter- based	Minimum Value Mode	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 will override 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 Patient and Encounter Level Encounter Based Scenarios.
Patient and Encounter	Encounter- based	Minimum Value Mode	By Percent/Flat Rate	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 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 Patient and Encounter Level Encounter Based Scenarios.
Patient and Encounter	Encounter- based	Flat Rate Mode	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 a 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 Patient and Encounter Level Encounter Based Scenarios.
Patient and Encounter	Encounter-based	Flat Rate Mode	By Percent/Flat Rate	The encounter level sliding fee schedule has precedence over the chart level and is applied for the cost estimation. 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 Patient and Encounter Level Encounter Based Scenarios.

Patient and Encounter Level Sliding Fee Scenarios

The following conditions are considered for cost estimation if sliding fee schedules are attached at both patient chart level and encounter level.

If a cost estimation is launched from an encounter which has a sliding fee schedule attached, then the encounter level sliding fee takes precedence over patient chart level sliding fee schedule.
If the cost estimation is launched from a patient appointment, and the appointment has an encounter attached to it, then any sliding fee schedule attached to this encounter takes precedence over a chart level sliding fee schedule.
If a cost estimation is not launched from an encounter or an appointment attached to an encounter, the patient chart level sliding fee schedule takes precedence.

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 using the UDS tab on the Modify Patient Information window.

A different sliding fee schedule is attached at an encounter level on the Encounter Maintenance window.

The following table lists the person and patient level sliding fee scenarios and their calculations.

Level	Schedule Fee Mode	Sliding Fee Mode	Min/Flat Rate Value Mode	Calculations
Patient and Encounter	Line Item-based	Minimum Value	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 minimum value resulting in a minimum amount of $20 to be paid by the patient. For more information, see Sliding Fee Calculations for Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Line Item-based	Minimum Value	By Percent/Flat Rate	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Line Item-based	Flat Rate Mode	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Line Item-based	Flat Rate Mode	By Percent/ Flat Rate	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 Patient and Encounter Level Line Item Based Scenarios.
Patient and Encounter	Encounter- based	Minimum Value Mode	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 will override 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 Patient and Encounter Level Encounter Based Scenarios.
Patient and Encounter	Encounter- based	Minimum Value Mode	By Percent/Flat Rate	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 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 Patient and Encounter Level Encounter Based Scenarios.
Patient and Encounter	Encounter- based	Flat Rate Mode	By Family Size	The encounter level sliding fee schedule has precedence over the chart level schedule and is applied for the cost estimation. 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 a 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 Patient and Encounter Level Encounter Based Scenarios.
Patient and Encounter	Encounter-based	Flat Rate Mode	By Percent/Flat Rate	The encounter level sliding fee schedule has precedence over the chart level and is applied for the cost estimation. 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 Patient and Encounter Level Encounter Based Scenarios.

Patient and Encounter Level Sliding Fee Scenarios

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