Est. Patient Responsibility

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Est. Patient Responsibility

Postby jeanetter » Wed Aug 06, 2014 3:54 pm

Does anyone use the estimated patient responsibility to determine what a patient will owe? I really like it, but am trying to figure out I can use it in the following example:

Billing for an AFO and shoes (non-diabetic and not attached to AFO)
AFO codes are payable by insurance carrier but shoes are not.

I can't indicate the shoes and inserts are non-covered on the fee schedule for this insurance carrier because they do pay for shoes and inserts for some policies. I'm hoping to avoid having to put in 2 claims. Any suggestion would be appreciated. Thank you!

Jeanette
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Re: Est. Patient Responsibility

Postby revpro1 » Wed Sep 10, 2014 7:48 am

You should be able to setup a separate procedure code to the allowable table and call it L1906-1 and indicate it is non-covered and then just select it in the line item section in lieu of the base L1906 procedure code that is already in the allowable table. Don't remember trying it in medflex but it sounds like a possible solution. Let me know how it works out.
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Re: Est. Patient Responsibility

Postby jeanetter » Wed Sep 10, 2014 8:47 am

I am working with John @ Medflex on a solution to be able to indicate a code is non-covered on the Order Entry screen. Thanks for the suggestion!
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Re: Est. Patient Responsibility

Postby revpro1 » Fri Sep 12, 2014 4:46 pm

Sounds good. Gotta love a good clean solution. Have a good weekend. Cheers.
AJ
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