Appointment

You can flag upcoming appointments that may allow for consent to balance bill (Out-of-Network Billing Consent), and manage the patient consent requirements from either of these pages:

• Eligibility and Phone page
• Appointment page

From either page, clicking Manage consent brings you to a new Out-of-Network Billing Consent pop-up window to manage the consent steps.

Best practice: If you intend to balance bill for applicable services, the No Surprises Act requires that you notify patients about a qualifying out-of-network provider within specified timeframes before their appointment and receive appropriate consent.

On the Eligibility and Phone page

 

1. Display the Eligibility and Phone page: On the Main Menu, click Calendar. Under APPOINTMENTS, click Eligibility and Phone List.

2. View — select Out-of-Network Billing Consent to display the new Filter fields.

   
   

3. Filter by consent status — Select a status:
   • All — Shows appointments with any consent status
   • Not required to inform patient — Shows appointments that have not been flagged as Out-of-network rates may apply, so patient consent is not available
   • Incomplete consent — Shows appointments with incomplete consent. (If you select Incomplete consent, both Needs cost estimate and Missing signed patient consent form are automatically checked. You can also select either status independently.)
   • Collected patient consent — Shows appointments with a signed patient consent form attached
4. The list appears with the following new Out-of-Network Billing Consent columns for each appointment:
   • Inform patient — Check the box Out-of-network rates may apply if applicable
   • Status — Shows current Out-of-Network Billing Consent status for each appointment that has been flagged as Out-of-network rates may apply. See Out-of-Network Billing Consent Status for details.
   • Action — Click Manage consent if needed to complete consent steps

On the Appointment page

 

1. Display the Appointment page: On the Main Menu, click Calendar. Under APPOINTMENTS, click Today's Appointments.
2. At the top of the Task Bar, select a specific Dept and Date, then click Go. The list of patients scheduled for that day appears below. Click a patient name in the schedule.
3. Review the appointment information. If the appointment has an out-of-network provider: at the bottom of the Appointment Information section, select Out-of-Network rates may apply.
4. The consent status and Manage consent button appear.

On either the Eligibility and Phone worklist or the Appointment page, you can see the current Out-of-Network Billing Consent status for each appointment that has been flagged as Out-of-network rates may apply. The status will change as the appointment moves through the steps in the patient consent process.

• Needs cost estimate — This status appears if the appointment has no cost estimate
• Missing signed patient consent form — This status appears if the appointment has a cost estimate but no signed consent form attached.
• Missing signed patient consent form / Form sent to patient on [MM/DD/YYYY at HH:MM pm] — This status appears if the appointment has a cost estimate, the consent form was sent to the patient, but no signed consent form is attached.
• Collected patient consent — This status appears if a signed consent form is attached to the appointment

On either the Eligibility and Phone worklist or the Appointment page, for each appointment that has been flagged as Out-of-network rates may apply, you can see the current Out-of-Network Billing Consent status and click Manage consent to complete the steps in the patient consent process.

Enter expected procedures and cost estimate

1. From either the Eligibility and Phone page or the Appointment page, click Manage consent.

2. The Out-of-Network Billing Consent window appears. The athenaOne system will use the information you enter here to populate the patient consent form.
   

    

   Cost estimate

   
   This estimate will include co-providers and/or co-facilities — When this box is checked, you are responsible for calculating and documenting the total cost estimate including costs for your practice and for each co-provider/co-facility.

   • Enter the total cost estimate on the Total cost only tab.
     

   • The consent form will include pages for you to write in the itemized services and subtotal for each provider and facility.
     

    

   Total cost only tab

    

   Total cost only tab
   Field name	Description
   Total cost estimate	Enter the cost estimate
   Alternative in-network providers	(Required for post-stabilization services) — Enter provider name(s) to be included on the HHS consent form

    

   

    

    

    

   If the estimate will NOT include co-providers and/or co-facilities:

   • Use the Itemized costs tab to enter up to ten specific procedure codes and estimated costs to populate the HHS consent form.

    

   Itemized costs tab

    

   Itemized costs tab
   Field name	Description
   Procedure code	Enter a CPT code or type a period to use the lookup
   Cost	Enter the estimated cost for the procedure
   Description	Displays a description for the procedure code entered
   Total cost estimate	Displays the total of the costs entered above
   Alternative in-network providers	(Required for post-stabilization services) — Enter provider name(s) to be included on the HHS consent form

    

    

   

    

    

3. Click Save.

4. If you’re ready to create and send the consent form to the patient, you can do that now. Otherwise, you can save now and return to the appointment later to send the form.

 

Create and send the Out-of-Network Billing Consent form for the patient to sign

 

1. From either the Eligibility and Phone page or the Appointment page, find appointments that have an Out-of-Network Billing Consent status: Missing a signed patient consent form (appointments in this status already have a cost estimate).
2. Click Manage consent. The Out-of-Network Billing Consent window appears.
3. Scroll to the bottom of the page and click Create form for patient to sign .
4. A digitized version of the HHS Consent Form appears, populated with the patient’s appointment data, cost estimate, and any procedure code(s) and alternative in-network provider(s) entered.
   
   Note: For details on what athenahealth populates in the form, see the athenahealth’s digitized version of the HHS Consent Form in the User Guide — athenaOne Support for Compliance with No Surprise Billing Legislation.
   

5. At the top of the form, you can choose to Send or Print the form.

    

   Note: If you selected This estimate will include co-providers and/or co-facilities, the Send button is not available. You must Print the consent form and write in the itemized services and subtotal for each co-provider and co-facility.

    

   
   

   

6. If you select Send:

1. Email form to — Select one of the following:
   • Patient (default)
   • Another recipient from the list of patient’s contacts on the patient registration record
   • Other — Enter the email for a contact that is not listed
2. Click Send
3. The athenaOne system sends an email with the form.
   
   Important: This form will only be available for 7 days and then will expire and need to be re-generated and resent to the patient

Attach patient's signed Out-of-Network Billing Consent form to an appointment

 

1. You will need to have a PDF file of the patient’s signed consent form.
2. Save the file to your system.
3. From either the Eligibility and Phone page or the Appointment page, find appointments that have the Out-of-Network Billing Consent status: Missing a signed patient consent form.
4. Click Manage consent. The Out-of-Network Billing Consent window appears.
5. Scroll to the bottom of the window and click Upload patient’s signed consent form .
6. Navigate to the location of the signed form on your system, select the file, then click Open.
7. Click Save .
   A message appears with details about who uploaded the file, along with a date/time stamp.

Important: If you reschedule an appointment, you must re-enter the consent information and re-attach the signed form. Be sure to have a copy of any signed consent forms before moving the appointment.

1. View an existing patient appointment that hasn't been checked in yet.

2. In the Cost Estimate section, you can create a self-pay cost estimate:
   

   
   

   Note: The Cost Estimate section will only appear if the patient's Primary Insurance is Self-Pay or No-Insurance/Self Pay.

    

   

   Tip: Click the image to see an expanded view

    

   Field name	Description
   Primary Insurance	(view-only)
   Department	(view-only)
   Upcoming appointment	(view-only)
   Procedure Code, Modifiers	Enter Procedure Codes and Modifiers for the patient's appointment.   This field uses the same Procedure Code Lookup which is available on many athenaOne pages such as Charge Entry and Claim Edit. Enter "." or "?" to search for a procedure code by description or code.   The following appears for each Procedure you enter: Description — The description of the procedure Cost — The cost of the procedure based on the Units entered and the fee schedule Note: You need at least one procedure code/procedure code-modifier combination to create a self-pay cost estimate.
   Units	Enter the number of units for the procedure.

3. Click Create Estimate.
   

4. The estimate appears, with a message letting you know the status of the estimate creation.

   
   

   

   Tip: Click the image to see an expanded view
   

    

   
   For customers using sliding fee plans:

   • A banner appears at the top: Cost estimate is created without any sliding fee plans
   • (Sliding fee discounts are currently not calculated in the total cost estimate, but we're planning to include them in the estimate in a future release.)

   
   

5. Click Print Cost Estimate to send the estimate to a printer.
6. If you share the cost estimate with the patient, click the box next to Cost estimate has been shared with the patient.

In the View Appointment page, once you have a cost estimate created for a self-pay patient, you can also create and share a Good Faith Estimate form (CMS-10791 form). The form can be printed or emailed to patients to support compliance with the No Surprise Billing legislation (i.e. No Surprises Act).

1. In the Cost Estimate section, click Create and share Good Faith Estimate (No Surprises Act: CMS-10791) .

   
   

   

    

   A pop-up window appears.

   
   

2. Create and share Good Faith Estimate (No Surprises Act: CMS-10791)

    

   

   Tip: Click the image to see an expanded view

    

    

   Field name	Description
   Procedure, Modifiers	(view only)
   Units	(view only)
   Description	(view only)
   Optional: Diagnosis code	Enter a diagnosis code for each of the CPT codes in the cost estimate. You can enter up to four Diagnosis codes for each CPT code.   Note: The system does not validate the diagnosis code. (Even if you enter an invalid diagnosis code, you can still generate the form.)
   Diagnosis description	(view only)
   Cost	(view only)
   Additional health care provider/facility notes	Enter any additional notes to appear on the Good Faith Estimate form. If you have sliding fee discounts, you can enter details here. This field is limited to 500 characters.

   
   

3. Click Create Form to generate a digitized copy of the CMS-10791 Good Faith Estimate for Health Care Items and Services form, with the following fields populated:

   
   

   Fields	Populated from...
   Patient information	the patient's appointment data and registration information in athenaOne
   Procedures/ Modifiers, Estimated Cost	information entered in the Cost Estimate section of the appointment
   Diagnoses/ Additional health care provider/facility notes	information entered in the Create and Share Cost Estimate window
   Provider details Street Address City State Zip Code Contact Person Phone Address where service/item will be provided	the provider specific to the appointment Department (the physical location where the services are rendered); if Department information is not available, then use provider from the Medical Group (except for the Contact field — if information is not available from the Department, the field is left blank)

    

   
   

4. Use the options at the top to email or print the form:
   

   • Email form to — Select one of the listed contacts from the patient's registration or select Other, which allows you to type in an email address.

   • Send — Email the form to the selected address.

   • Print — Print the form.
     

      

     

    

   See the Good Faith Estimate — generated email and form (images) section below for an example of the generated email and form.

   
   

5. Close the window to return to the Cost Estimate section in the View Appointment page.

6. After you have created and shared a Good Faith Estimate, you'll see different options at the top of the Cost Estimate section:
   

    

   

   
   

    

   Link	Description
   Share existing Good Faith Estimate Last shared: MM/DD/YYYY	Click this to share the existing version of the Good Faith estimate form(CMS-10791 Form), which was printed or emailed to the patient upon creation of the form.   The timestamp shows when it was last shared.
   Create and share new Good Faith Estimate	Click this to create a new version of the form. The pop-up window appears — enter the Diagnosis Codes and Additional Notes. Then click Create Form to generate a new version of the Good Faith estimate form with the updated Diagnosis Codes and Additional notes.

Good Faith Estimate — email sent to patient

 

This is an example of the email that is sent to the patient if you choose to email from the Create and share Good Faith Estimate (No Surprises Act: CMS-10791) window:

 

Tip: Click on the image to see an expanded view

 

Good Faith Estimate — athenahealth's digitized version of the CMS-10791 form

 

 

This is an example of the form that is created from the Create and share Good Faith Estimate (No Surprises Act: CMS-10791) window:

 

Tip: Click on an image to see an expanded view

 

 

 

 

 

 

 

Note: 

• Once a patient is checked in, you can no longer go back to the Appointment page and therefore can no longer update the cost estimate.

• Once a claim is created for an appointment, you can no longer view or change the cost estimate.

1. View an appointment that has not been checked in yet.

2. In the Cost Estimate section, click Update Estimate .

3. Procedure Code, Modifiers — Add, edit or remove Procedure Codes and Modifiers.

4. Click Create Estimate to update the existing estimate, or click Cancel.
5. If you updated the procedure/modifier combinations and then click the Create and share new Good Faith Estimate link, you'll see the updated cost estimate in the pop-up window and the workflow continues as explained above.

If there is a change in any of the Appointment information used in the cost estimate, the cost estimate will need to be updated (refreshed).

1. Display the Appointment page: On the Non-Clinician home page, click a patient name in the schedule.
2. Click Start Check-in.

1. Rendering — Ensure that the selected rendering provider is correct.
   Note: If the Supervising provider field appears and the rendering provider has been designated as requiring cosigner oversight, enter the supervising provider in the field.
2. Primary insurance — Verify that the correct primary insurance is selected, or edit the selection.
3. Secondary insurance — Verify that the correct secondary insurance is selected, if needed, or edit the selection.
4. Notes/Reason — Add any notes for this appointment.
   Caution: You cannot delete an appointment note after you add it.
   
5. Authorization — Select an authorization (if required by the patient's insurance policy).
   Note: You can select authorizations with a status of Not Required.
6. Patient's condition related to — If the patient's condition is related to employment, an auto accident, or other accident, set the appropriate field to Yes. The Patient's condition fields drive referral rules and are used as the default values when you create a claim. (If you change the Appointment Insurance, these fields automatically change to reflect the newly chosen policy.)
7. If the patient's condition is employment-related or MVA-related, you must add a case policy: click the Add case policy link (in the Insurances section).
   See Add Case Policy for more detailed instructions on adding a case policy.

1. Verify the patient's registration information to ensure that the patient address and phone number are current and correct.
2. Patient notes — You can enter a patient note in this field. The notes you enter here also appear in the Patient notes field on the Quickview and Patient Registration pages. The note is not printed on any form.
3. Portal access —  If your practice uses the athenaCommunicator Patient Portal, the URL is the Patient Portal URL.
   
   If your practice does not use the athenaCommunicator Patient Portal:
   The Patient Information Center URL is: https://YOURPRACTICEID.portal.athenahealth.com/
   (Your practice ID is located in the title bar of your athenaOne window.)
    If your practice uses provider groups, add a dash and digit after your practice ID to distinguish the different provider groups:
   https://YOURPRACTICEID-1.portal.athenahealth.com/
   https://YOURPRACTICEID-2.portal.athenahealth.com/

1. Request the patient's insurance card, and scan or make a copy of the insurance card.
2. Verify the insurance information displayed on this page using the information on the card. Make corrections if needed.
3. (athenaCollector) You can click view detail to display the Eligibility Detail page and view the full eligibility text without rechecking eligibility.
   Note: Claims denied for eligibility related reasons (for example, service not covered, wrong insurer, patient demographic issues), take 20 to 50 days longer to pay than "clean" claims, so eligibility checking is critical to your cash flow.

The Payment and Balances section provides the following information, making it easier for you to review outstanding balances.

• Bad debt, unapplied money, and pre-existing card on file agreements appear above the Today's Visit information.
• If a card on file agreement needs to be updated (for example, when the card on file limit is about to run out or the card is about to expire), an alert appears.
• Save card option allows you to save a card on file outside the TOS payment collection workflow.
• Claims in hold, statements in hold, and balances in other provider groups appear below the information in the Payments and Balances section.

Note: If you prefer to do most collection at checkout instead of check-in, you can contact the CSC by selecting Support > Create Case or Call in the Main Menu to request this change.

To collect a patient payment using Credit Card Plus

 

You must have Credit Card Plus activated to collect credit card payments.

1. During Check-in (or Checkout), scroll down to the Payment and Balances section.
2. Review the information about outstanding balances, bad debt, and pre-existing card agreements.

Past Visits

3. Outstanding balance — If the patient has an outstanding balance, enter a payment in this field, even if it is $0.00.
   If the patient cannot pay the full amount or any of the outstanding balance, select the reason from the Reason for not collecting in full menu.
4. Balance sent to collections — If the patient has balances that were sent to a collection agency, you can click Show details to display this information. You can collect a full or partial payment for this balance. Any payment made is posted as a recovery adjustment and decreases the patient's collections outstanding amount.

Today's Visit

5. Copay — Enter the copay amount that the patient gives you.
   Note: If the patient has secondary insurance, a message states that a copay may not be required. If you want athenaOne to automatically set the default copay amount to $0 when a patient has secondary insurance, contact your Customer Success Manager.
• If the copay type is not correct, click Edit, then select the correct copay type from the Copay menu. You can see the copay types and amounts for the insurance package under the Insurances heading.
• If athenaOne automatically sets the default copay amount to $0 for patients with secondary insurance, you can click the Reset link to enter a copay amount.
  Note: For more information, see Copays for patients with secondary insurance policies.
• If you enter a dollar amount smaller than the total copay amount, the Reason for different co-pay menu appears.
6. Reason for different co-pay — If the patient does not pay the full copay amount, select the reason for not collecting the full copay from the menu, for example, Patient was unable to pay or Co-pay may not be correct.
7. Additional payment for today's services — Enter any additional payments.
8. Click Next.

How will the patient pay?

9. Payment type — Select Credit Card.
10. Card on File — Select one of these options:
• Yes, authorize card — This option saves the credit card as a card on file for future payments.
• No, patient declined

Note: If you do not make a selection, a message appears asking you to do so.

11. Yearly limit (Optional) — Click Edit to change the annual or single-visit limit for the saved card, then click Save.
12. Click Collect Payment.
    A new window appears.
13. Swipe or insert the credit card, or enter the card information manually.
14. Billing address — Enter the patient or guarantor's address information.
15. Click Collect Payment.

To collect a patient payment with cash or check

1. During Check-in (or Checkout), scroll down to the Payment and Balances section.
2. Review the information about outstanding balances, bad debt, and pre-existing card agreements.

Past Visits

3. Outstanding balance — If the patient has an outstanding balance, enter a payment in this field, even if it is $0.00.
   If the patient cannot pay the full amount or any of the outstanding balance, select the reason from the Reason for not collecting in full menu.
4. Balance sent to collections — If the patient has balances that were sent to a collection agency, you can click Show details to display this information. You can collect a full or partial payment for this balance. Any payment made is posted as a recovery adjustment and decreases the patient's collections outstanding amount.

Today's Visit

5. Copay — Enter the copay amount that the patient gives you.
   Note: If the patient has secondary insurance, a message states that a copay may not be required. If you want athenaOne to automatically set the default copay amount to $0 when a patient has secondary insurance, contact your Customer Success Manager.
• If the copay type is not correct, click Edit, then select the correct copay type from the Copay menu. You can see the copay types and amounts for the insurance package under the Insurances heading.
• If athenaOne automatically sets the default copay amount to $0 for patients with secondary insurance, you can click the Reset link to enter a copay amount.
  Note: For more information, see Copays for patients with secondary insurance policies.
• If you enter a dollar amount smaller than the total copay amount, the Reason for different co-pay menu appears.
6. Reason for different co-pay — If the patient does not pay the full copay amount, select the reason for not collecting the full copay from the menu, for example, Patient was unable to pay or Co-pay may not be correct.
7. Additional payment for today's services — Enter any additional payments.
8. Click Next.

How will the patient pay?

9. Payment type — Select Cash/Other.
   Note: The Check option in the Payment type menu is for electronic checks only. For personal checks from patients, select Cash/Other from the Payment type menu.
10. Payment method — Select Check or Cash.
11. If you selected Cash as the payment method, click Collect Payment.
12. If you selected Check as the payment method:
1. Check number — Enter the check number.
2. Click Collect Payment.

Collect Patient Bad Debt Balance During Check-in at Time of Service

You can collect patient bad debt balances at the time of service.

Note: This feature improves the payment collection workflow at TOS. However, it does not change your existing workflows. You can continue to collect patient balances via cash, credit card, and check as you normally would.

 

Click Show details to expand more information

The patient bad debt balance appears in the Bad debts field of the Patient Balances section.

 

You can click Show details to display additional information about the patient bad debt balance.

Non-family patient view

1. Bad debts — In Bad Debts field, enter the amount you intend to collect.
   Note: Click Collect All to collect the entire amount in the Total due field.
2. Enter any other amounts for outstanding balances or copay per your usual workflow.
3. Click Continue.
   The Total amount to be collected section appears
4. Payment type — Select an option from the list.
5. Payment method — Select an option from the list.
6. Click Collect Payment.
   Note: There is no change to the patient receipt but it does additionally list the bad debt money collected at charge level as outstanding money collected.

Family billing patient view

1. Bad debts — In Bad Debts field, you can:
   Note: Click Collect All to collect the entire amount in the Total due field.
   1. Enter the amount you intend to collect in the Bad Debts field.
      
   2. Family Outstanding balance — Enter an amount in the Family Outstanding balance field or click View individual balances to enter amounts for specific family members of the patient.
      
2. Once you choose how to collect the patient bad debt balance, enter any other amounts for outstanding balances or copay per your usual workflow.
   
3. Click Continue.
   The Total amount to be collected section appears.
4. Payment type — Select an option from the list.
5. Payment method — Select an option from the list.
   
6. Click Collect Payment.
   Note: There is no change to the patient receipt but it does additionally list the bad debt money collected at charge level as outstanding money collected.

Collect a partial or zero dollar amount

If there is a partial amount or no amount collected against the bad debt, you can select a reason from the Reason for not collecting in full list. If you select 'Other', enter details in the note/comment field.

If you choose to collect zero (0.00) dollars at TOS, you’ll see a message informing you that no payment was collected from the patient.

Note: There is no change to the patient receipt but it does additionally list the bad debt money collected at charge level as outstanding money collected.

1. You can print a Receipt if you collected money during check-in.
2. You can print the appropriate billing slip and any forms needed for this visit.
3. Click Done with Check-in..
   In the Non-Clinician view of the schedule, checked-in patients are indicated by the "Ready for Staff" status.
   
   Note: If you check in a patient for an appointment related to an accident or work-related injury and the patient has no active case policy, the Case Policy Alert page appears when you click Done with Check-in. The Case Policy Alert page provides buttons that allow you to create a new case policy or continue the workflow without creating one.

If you intend to balance bill for applicable services, the No Surprises Act requires that you notify patients about a qualifying out-of-network provider within specified timeframes before their appointment and receive appropriate consent. This functionality is available if the No Surprises Act Consent feature has been enabled for your practice. For reference, see the User Guide — athenaOne Support for Compliance with No Surprise Billing Legislation.

You can use the Self-Pay Cost Estimate tool to generate a cost estimate for self-pay patients when viewing an appointment that hasn't been checked in yet.

1. Enter the expected procedures/modifiers for the appointment.

2. The athenaOne system generates an estimate based on costs defined in your fee schedules.

Benefits:

• Surface cost estimates to patients before the encounter
• Automatically pull from your organization's fee schedule based on entered CPTs
• Create and share a Good Faith Estimate (CMS-10791 Form), to support No Surprise Billing for self-pay patients
• Improve transparency between your organization and patients, increasing probability of patient payment
• If the patient cannot pay an outstanding balance in full, offer a clearly defined payment plan.

The Patient Validation Rules report provides visibility into staff behavior and creates training opportunities for your practice. This report, which you can find on the Front Office Operations tab of the Report Library, displays the following information:

• For each user and each rule, the number of times that the user dismissed the rule at check-in.
• Number of claims created in HOLD with that rule.