1)      Search for patient.

2)      Select date of service – estimate.

3)      Select criteria for Company, Facility, and Provider (this combination determines the correct fee schedule to look for to determine allowable amounts).

4)      Based on criteria for steps 1 through 3 the system determines the appropriate fee schedule from CPS.

5)      Deductible information populated from most recent 271 eligibility file if available.

6)      Current tickets in CPS with outstanding patient balances.

7)      Add codes to be billed for during procedure/surgery, number of units, and the Fee is actually the allowed amount based on the determined fee schedule.  If no allowed amount is available, the fee for the code will be used instead.

8)      Option to select a modifier for the code, if a modifier is associated with the fee schedule.

9)      Allowed amount from CPS fee schedule.  If an Allowed amount is not available for the fee schedule, calculations will be based on the Fee for the procedures.  If
a modifier has been selected, the allowed amount will be based on the modifier percentage of the allowed amount.

10)   Total surgery/procedure cost.

11)   Discount– if you opt to give the patient a discount based on flat fee or percentage.

12)   Current patient outstanding balance.

13)   Copayment calculation if applicable for a specific code used during procedure.

14)   Deductible from 271 file (or may be manually entered)

15)   Co-insurance percentage as entered by user.

16)   Determine whether to calculate patient responsibility by CPT code or globally at the visit level.

17)   Out of Pocket maximum if applicable.

18)   Total Cost = calculation of surgery/procedure cost plus current outstanding balance.

19)   Deposit due amount (if applicable).

20)   Patient payment plan amount (if applicable).

21)   Due date for payment plan each month (if applicable).

22)   Notes that should appear on the Patient Estimate Letter and/or Payment Plan document.

23)   Option to attach a copy of the letter to Patient Registration (see below).

24)   Indicates option to create Payment Plan document.

**The Clear Selections button will clear all fields and information in the window.