Patient Responsibility Estimator (PRE)

Patient Responsibility Estimator (PRE)


Patient Responsibility Estimator (PRE)

NotesThe 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.
  1. Learn More: Estimator Criteria and Calculations
Info
This estimation is for Primary Insurance only.

The No Surprises Act

  • No Surprises Act
    • 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."
    • These new billing protections under the No Surprises Act are an excellent reason to use the Patient Responsibility Estimator Tool. (This is a Premium Add-On Feature.)

Access the Estimator Tool

Once you add the Estimate tool to your PM System subscription, you can access it on:
  1. The Patient Appointment screen: Select the Estimate button.
  2. The Patient Dashboard: Select Estimate History link.
  3. The Estimate icon on the top right icon menu.





Alert
**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

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