Patient Responsibility Estimator (PRE)

Patient Responsibility Estimator (PRE)


Patient Responsibility Estimator (PRE)


 The Patient Responsibility Estimator is a premium add-on to your PM system. Contact our Sales Department for more information.


Using the Estimate Patient Responsibility icon allows you to provide accurate patient responsibility estimations without using a third-party tool. This tool utilizes the patient data in your System.


The Estimation Tool can be accessed from the Estimate button on the Appointment screen and the Patient Estimate History link on the Patient Dashboard.

Once you add the Estimate tool to your PM System subscription, you will see the option on the toolbar (fourth icon).


**A current Eligibility Check is required to return an accurate, confident estimation
.

Select the Estimate link on the Patient Dashboard, to auto-fill the following Patient information in the Patient/DOS Panel.

Patient/DOS Panel

  1. Name, DOB, Age, Sex (Select Clear All to delete the auto-fill)
  2. Use the Edit link to navigate to the Patient Dashboard to make changes.
  3. DOS: Defaults to Today's date.


Policy Panel

  1. Insurance: Insurance Name, Policy Number, Group, Group Name, Plan, Product, Assignment
  2. Edit Icon: Select to navigate to the Insurance Policy Information screen to make changes to the Policy.
  3. Insurance Management: Select the link to navigate to the Insurance Management screen to make changes to the Policy Profile.
  4. Eligibility as of: Defaults to current date. Selecting the link displays the current Eligibility report.
  5. DOS: Displays the Date of Service from the entry in the Patient/DOS panel above.
  6. Eligibility Status for the Eligibility as of date.
  7. Use the Verify Eligibility button to check Eligibility again.
  8. Select the Choose Previous Eligibility link to select a previous Eligibility check.


Out-of-Pocket Panel

The information in this panel, populates from the Eligibility Check.

  1. Select the radio button to see the results for In-Network or Out-of-network.
  2. Copay Type: Select the Type of Copay from the dropdown to see the Eligibilty report results and estimation results.
  3. Co-Insurance Type: Select the Co-Insurance Type from the dropdown.
  4. Deductible Type: Select the type of Deductible if applicable. The options depend on how your Eligibility Search is set up.
  5. OOP (Out-of-Pocket) Type: Same concept as Deductible Type.
  6. Patient Responsibility

Procedures Panel Options

  1. Select Procedures From a Previous Service.
  2. Select an Estimate From a Previous Estimate.
  3. Use the Clear link to delete information in this panel.
  4. A Facility can be selected.
  5. Select a Rendering Provider if applicable.
  6. Select a Billing Provider if applicable.
  7. Enter one or more CPT® Codes along with Modifiers and Units.
  8. Confidence level of Estimation.
  9. Breakdown of Patient Responsibility
  1. Depending on the choices made, some fields will be open to manually entered percentages and/or dollar amounts.
  2. The Co-Insurance and Discount fields will accept dollar amounts and percentages.
  1. Save, or
  2. Save/Print: Use this Save option to print the Estimation.



Co-Insurance/Discount Percentages 

The Co-Insurance and Discount fields can be calculated manually by entering Percentages or dollars.

  • Percentage for Co-Insurance: Enter the Percentage rate in the Co-Insurance field.

    • Upon leaving the field, the Percentage changes to the calculated dollar amount.

  • Percentage for Discount: Enter the Percentage rate in the Discount field.

    • Upon leaving the field, the percentage remains in the field.

    • The calculated dollar amount displays beneath the field.



Example of a Completed Estimation


Estimate History

The Patient's Estimate History can be viewed from the Patient Dashboard.

  • In the Active Policies panel, select the Estimate History link.

  • Patient Estimate History Screen



  • Printed Estimate Output



No Surprises Act

The Requirements related to Surprise Billing provide additional protections against surprise medical bills. These new billing protections under the No Surprises Act are an excellent reason to use the Patient Responsibility Estimator Tool. The Patient Estimate output has the information to give a "Good Faith Estimate."
  • CMS/No Surprise Act: "Through new rules aimed to protect consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network."


® CPT copyright 2019 American Medical Association. All rights reserved

    • Related Articles

    • Pre-Payment Setup

      Pre-Payment Setup This workflow is for groups who choose to leave Pre-Payments in escrow as unposted. Example: Surgical Procedure will be performed where the Patient has all or partial responsibility. The office expects a Pre-Payment before the ...

    • Patient Responsibility Overview

      Patient Not Responsible for a Specific Insurance Patient Not Responsible on the Patient / Encounter Level Patient Responsibility Estimator (PRE)

    • Pre-Collections Worklist

      Generate a Pre-Collections Worklist There are two ways the Pre-Collections Worklist can be generated. The Pre-Collections list can be manually created. If no No Dunning Limit was selected in the Statement Profile, the Make List button can be used to ...

    • Post a Pre-Payment

      This workflow is for groups who choose not to leave Receipts in Escrow for prepaid services. This process works well for paying providers before services are rendered. Create an Incomplete Charge On the Post Charge screen, select Self-Pay from the ...

    • Estimator Criteria and Calculations

      Patient Responsibility Estimator Criteria As more information is entered into the Estimator, the higher the potential confidence level for the Estimate. Patient/DOS A Patient and DOS are required to evaluate Estimation. This will be used to ...