Office Therapy - Managing and Reporting Insurance and Provider Rates

AA-00374

Managing and Reporting Insurance and Provider Rates

Set Allowed Benefits for Insurance company

Go to the Insurance View, select the company, and select the Rate Card tab.
Select the Service or CPT and enter the Allowed benefits (what the insurance company allows – e.g for a 90834 the allowed is $100 and the percentage paid is 80% or $80

Set the Provider’s Rates

Go to the Provider view, select the provider and select the Rate card tab.
Select the Service or CPT and enter the provider’s rate (e.g. for 90834, enter $120)

Setup the Client’s Standard Charge

Go to the Client view and select a client
Set the Provider and Primary Insurance for the client
Go to the Standard Charge tab
Select the Service or CPT (e.g. 90834). The Provider Fee and Fee Reduction, and distributions will auto-populate (e.g. Fee =$ 120, Fee Reduction $20, Allowed Fee = $100, Client responsibility = $20, Insurance responsibility = $80)
Enter a charge for the client and save

Report Showing Provider Fee / Allowed Difference

Select Report Essentials from the Reports menu
Expand the Insurance Management and then the Insurance Charge Detail reports
Select the "For Primary by Client" Report

- Select a Date Range and then on the Clients tab, select Selected Clients Only and then select the client. You can select All Clients, All or a specific Insurance company, All or a specific Provider, and also filter on Charge Types.

The report will show the provider Fee, Reduction, Insurance Allocation, any Adjustments, Insurance Responsibility, Insurance Payments and the Total Due.