Sliding Fee Programs

athenaCollector

This page allows you to define sliding scale fee programs for use in your practice. After you define a program, the next step is to define the level of patient responsibility by creating a sliding fee plan using the Non-Poverty-Based Sliding Fee Plans or the Poverty-Based Sliding Fee Plans page. You can create various plans within one sliding fee program. Each plan has its own levels of patient responsibility. You can also add exceptions to sliding fee programs.

 

On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Sliding Fee Programs

 

 

 

Your practice must have the Sliding Fee Programs feature enabled. In addition, your practice must have the Post-Adjudication Sliding Fee Plans feature enabled to perform these tasks:

  • Add a poverty-based sliding fee program
  • Add a poverty-based sliding fee plan
  • View the Health & Human Services (HHS) poverty guidelines table
  • Apply a poverty-based sliding fee plan to a patient
  • Edit a patient's existing poverty-based sliding fee plan
  • Adjust sliding fee plan balances automatically after primary and/or secondary payer adjudication

To access the Sliding Fee Programs, Non-Poverty-Based Sliding Fee Plans, and Poverty-Based Sliding Fee Plans pages, you must have the Practice Set-Up: Sliding Fee Programs/ Plans permission.

 

 

 

 

Note: To create poverty-based sliding fee programs, your practice must have the Post-Adjudication Sliding Fees feature.

  1. Display the Sliding Fee Programs page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Sliding Fee Programs.
  2. Click Add new.
  3. Name — Enter a unique and descriptive name for the program (required field).
  4. Poverty-based? — Click Yes (required field).
  5. Ordering — Enter a number to indicate the order in which this program will appear.
  6. Note — Enter a description of the program or notes about the program (recommended).
  7. Department exclusions — Click None to include all departments in the program, or click Selected and select the departments to exclude from the sliding fee program.
  8. Provider exclusions — Click None to include all providers in the program, or click Selected and select the providers to exclude from the sliding fee program.
  9. Transaction reason exclusions — Click None to include all transactions in the program, or click Selected and select the transaction reasons to exclude from the sliding fee program.
    Note: You can exclude copay, coinsurance, deductible, and other balances from the program.
  10. Procedure code group exclusions — Click None to include all procedure code groups in the program, or click Selected and select the procedure code groups to exclude from the sliding fee program.
  11. Procedure code modifier exclusions — Click None to include all procedure code modifiers in the program, or click Selected and select the procedure code modifiers to exclude from the sliding fee program.
  12. Procedure code exclusions — Enter the procedure codes to exclude. You can type a period (.) in the fields to display the Procedure Code Lookup tool.
  13. Click Save.

 

  1. Display the Sliding Fee Programs page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Sliding Fee Programs.
  2. Click Add new.
  3. Name — Enter a unique and descriptive name for the program (required field).
  4. Poverty-based? — Click No (required field).
  5. Ordering — Enter a number to indicate the order in which this program will appear.
  6. Note — Enter a description of the program or notes about the program (recommended).
  7. Department exclusions — Click None to include all departments in the program, or click Selected and select the departments to exclude from the sliding fee program.
  8. Provider exclusions — Click None to include all providers in the program, or click Selected and select the providers to exclude from the sliding fee program.
  9. Transaction reason exclusions — Click None to include all transactions in the program, or click Selected and select the transaction reasons to exclude from the sliding fee program.
    Note: You can exclude copay, coinsurance, deductible, and other balances from the program.
  10. Procedure code group exclusions — Click None to include all procedure code groups in the program, or click Selected and select the procedure code groups to exclude from the sliding fee program.
  11. Procedure code modifier exclusions — Click None to include all procedure code modifiers in the program, or click Selected and select the procedure code modifiers to exclude from the sliding fee program.
  12. Procedure code exclusions — Enter the procedure codes to exclude. You can type a period (.) in the fields to display the Procedure Code Lookup tool.
  13. Click Save.

 

  1. Display the Sliding Fee Programs page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Sliding Fee Programs.
  2. Click edit next to the sliding fee program in the table.
    The Edit Sliding Fee Program view appears at the top of the page.
  3. Poverty-based? — Click Yes or No.
    Note: We recommend that you not edit this field. Instead, create a new poverty-based or non-poverty-based sliding fee program.
  4. Ordering — You can use this field to change the order of this program.
  5. Note — Edit the description of the program, if necessary.
  6. Department exclusions — Click None to include all departments in the program, or click Selected and select the departments to exclude from the sliding fee program.
  7. Provider exclusions — Click None to include all providers in the program, or click Selected and select the providers to exclude from the sliding fee program.
  8. Transaction reason exclusions — Click None to include all transactions in the program, or click Selected and select the transaction reasons to exclude from the sliding fee program.
    Note: You can exclude copay, coinsurance, deductible, and other balances from the program.
  9. Procedure code group exclusions — Click None to include all procedure code groups in the program, or click Selected and select the procedure code groups to exclude from the sliding fee program.
  10. Procedure code modifier exclusions — Click None to include all procedure code modifiers in the program, or click Selected and select the procedure code modifiers to exclude from the sliding fee program.
  11. Procedure code exclusions — Enter the procedure codes to exclude. You can type a period (.) in the fields to display the Procedure Code Lookup tool.
  12. Click Save.

Note: You can click Audit history (above the Save and Cancel buttons) to display the history of all changes made to this sliding fee program.

 

 

 

 

 

You can add exclusions to sliding fee programs across multiple parameters:

  • Service department
  • Rendering provider
  • Transaction reason
  • Procedure code group
  • Procedure code modifier
  • Procedure code

If a procedure that is subject to a sliding fee plan meets any of the parameters you set on the Sliding Fee Programs page, that procedure will not slide. For example, if there are two procedures on a claim and one belongs to an excluded procedure code group, has an excluded modifier, or is excluded as a single procedure code, that procedure will not slide, whereas the other procedure will. If the claim was billed with an excluded provider or department, neither procedure would slide.

 

The ability to create custom exclusions from sliding fee arrangements gives you greater flexibility when creating sliding fee programs. For example, you can set up mutually exclusive sliding fee programs for various departments, elective procedures can be excluded, or dummy modifiers can be used to exclude procedures on a case-by-case basis.

 

 

 

The sliding fee programs and plans are available in the advanced view of the Accounts Receivable Aging Wizard and the Activity Wizard. Select the appropriate program from the list and then click the Sliding Fee Plans checkbox to receive a breakdown of the individual plans.

 

 

 

Sliding Fee Programs table
Name

Name of the sliding fee program.
Poverty-Based?

Yes indicates a poverty-based sliding fee program.

No indicates a non-poverty-based sliding fee program.
Ordering Number indicating the order in which this program will appear in menus.
Note

Any notes about this program.
Department Exclusions

Departments excluded from the sliding fee program.
Provider Exclusions

Providers excluded from the sliding fee program.
Transaction Reason Exclusions

Transaction reasons excluded from the sliding fee program. These balances can be excluded from the sliding fee program: copay, coinsurance, deductible, and other.
Procedure Code Group Exclusions

Procedure code groups excluded from the sliding fee program.
Procedure Code Exclusions

Procedure codes excluded from the sliding fee program.
Procedure Code Modifier Exclusions

Procedure code modifiers excluded from the sliding fee program.

 

Related Topics Link IconRelated Topics