Patient Cost Estimator

Introduction to Patient Cost Estimator

Patient Cost Estimator Overview

Patient Cost Estimator Overview Video

Patient Cost Estimator Screen

The Patient Cost Estimator is accessible from:

iScheduler
- Select patient in search tool, select index card drop down on Patient
- Right click on appointment
Patient Setup under More
Claim window
- Dropdown on Patient, select Cost Estimator
Billing Portal
- Index card drop down on the toolbar
- Claim Query, Patient drop down on the toolbar
- Claim Account Query, Patient drop down on the toolbar
EMR
- Index card drop down on Patient

Fields

Last Estimate

*This field isn't visible until an estimate has been created

Appt Type: The type of appointment used to build this estimate
Provider: The clinician assigned to the estimate
Insurance: The insurance company assigned to the estimate
Allowed: The amount assigned under CPT setup
Patient: The patient assigned to the estimate
Quote Date: The date this estimate was created

New Estimation Lines

Date of Service: The expected service date for the estimate
Payer: The insurance payer used for services
Provider: The clinician to perform services
Service Location: The location where services are expected to be performed

Lines

Date of Service: The expected service date for the estimate
Procedure: CPT for this estimate
Diagnosis: Diagnosis code for this estimate
Modifiers: Any modifiers that need to be included affecting charge such as -50 (bilateral)
Units: Quantity of procedures included in estimate for that line
Billed per Unit: Fee schedule in CPT Setup
Allowed per Unit: Allowed amount in CPT setup
Billed Total: Total of Billed per Unit amounts
Allowed Total: Total of Allowed per Unit amounts
Action: Allows user to remove or edit line

Add Line by Appt Type: Use this to add a service line for estimation by the type of appointment. Dependent on being fees being added in the Appt Type setup

Add Line by Manual Entry: Allows user to enter a line by CPT code for estimate

Patient Benefits

Insurance Plan: The Insurance benefits that will be used for this estimate
- Check Eligibility: To run verification of benefits against the payer
- Manual Entry: Allows user to manually enter benefit information
Network: This setting will be used to look at In or Out of Network benefits by category
- In Network: The provider accepts this insurance plan
- Out of Network: The provider does not accept this insurance plan
Coverage Category: Determines the insurance benefit category to look at such as Health coverage, Durable Medical Equipment, Allergy
Last Eligibility Check: The last time a verification of benefits was ran within the software
Calculate: Run the Patient Cost Estimator with the data displayed
Accept: Save the current estimate
Summary: This is a detailed lay out of the estimate. Click the print icon to print

Summary

This area calculates line by line based on information received or entered in the Patient Benefits section. It lists in order benefits are prioritized by the payer.

Copay: 1st Calculation- This line subtracts the Copay from the Allowed Total
Deductible: 2nd Calculation- This line takes the remainder from the Copay line and subtracts that from the deductible remaining
- Individual: Displays remaining deductible from met deductible in this category
- Family: Displays remaining deductible from met deductible in this category
Co-insurance: 3rd Calculation- This line takes the remainder from the deductible line and subtracts the coinsurance
Total for Now: 4th line Final Total- Estimate of the patient and insurance responsibilities

Patient and Insurance Columns: These are calculated line by line, it should not be interpreted as a duplicate entry or as a calculation of Insurance responsibility for that specific category. *For Line 1 Copay calculation, the red box does not indicate the insurance has a copay responsibility, it merely shows the calculation for that line.

Accessing Patient Cost Estimator

Patient Cost Estimator Insurance Workflow

Insurance Workflow

1. Payer, Provider and Service Location are required fields and must be entered to proceed with Cost Estimator. Type into the field and select Search or select Search first to view a complete list, then select.

When initiating a Cost Estimator from the Patient Setup screen, certain fields may not be pre-filled. Payer will load based on the patients primary payer in Patient Setup screen.

2. Add a line by Appt Type or Manual Entry

Add Line by Appt Type – Use this to add a service line for estimation by the type of appointment

This will search appointment types specific to your practice. Associating CPTs with Appointment Types is required to utilize this feature

Add Line by Manual Entry – Use this to manually add a CPT for estimate

This allows the user to enter a specific CPT code as well as Diagnosis code and modifier if needed.

Note required fields specified with the *. Depending on your CPT setup Unit, Charge per Unit and Allowed per Unit may populate with the CPT selection. However, this screen allows manual entry as well as override.

Below is an example of both entries in a single estimate

Note the Action column which allows a line to be deleted or edited.

3. Once line(s) have been added, choose whether you need to run a new eligibility check or manually enter benefits.

Check Eligibility - Opens Patient Eligibility screen to select insurance to run

Manual Entry - Opens a screen allowing user to hand key items

4. Choose whether you’ll need to use In Network benefits or Out of Network benefits

5. Coverage Category can be changed to run benefits for different care such as Durable Medical Equipment (DME), Allergy testing, etc.

5. Select Calculate to run the estimate

6. Once estimate has been created and reviewed for accuracy, click Accept to lock and save this estimate. If changes need to be made, make those then select Calculate before Accept.