Reimbursement Contracts Flashcards
Explain the purpose of reimbursement contracts Create and configure a reimbursement contract Discuss the benefits and challenges of using reimbursement contracts
Where do allowed amounts come from?
Reimbursement contracts
Why is building reimbursement contracts valuable for organizations?
It allows you to report on any discrepancies between your allowed amount and the allowed amount sent by the payor.
Reimbursement contract security is not controlled by PB security class. What security classes is it controlled by?
Contract Manintenance security.
What is the default in the General Settings Key Field “When to apply”?
Both Claims and Charge Entry
In the service components tab of a reimbursement contract form, is the order of the row important?
Yes. the system reviews the lines in the order entered so more specific rows should be listed above more general rows.
What is the Payment Mechanism column in the Service component tab?
Fee schedule, percent of billed, percent of fee schedule, maximum of FS, etc.
In the service component tab what is fee schedule #2? and which payment mechanisms can be used with this field?
The second fee schedule to be used in determining payment. Use Maximum/Minimum of fee schedules ; max/min of options
In the Service component tab, what is % of fee schedule? and which pmt mechanisms can you use?
Epic applications take the specified percentage of the first fee schedule. Use Percent of Fee schedule or Maximum/Minimum of options.
What is the percent billed field in the service component tab? Which pmt mechanisms can you use?
the percentage of the billed amount to be used to determine the payment. Use Percent of Billed or Max/min of options.
What is the “continue?” window in the service component tab?
If it’s set to YES it will look to the next contract line for an allowed amount if it didn’t find find one in a previous line.
In the “applies to” tab, items listed within itself has an (and/or) relationship. Characteristics between items have (and/or) relationships.
OR. AND.
If a charge meets the “applies to” requirements of multiple reimbursement contracts, how will it determine which one to use?
Set precedence in Service area profile in text
If the Reimbursement contract precedence is left blank, in what order will it default to?
Provider>Network>Plan>Payor>financial class>department>department specialty>location>SA
When you click on the test utility after you build your contract what happens to the invoice you’re testing?
Nothing, it’s hypothetical.
If changes or corrections are made to a reimbursement contract, it is possible to re-evaluate the allowed amounts and associated write-offs for charges affected by that contract by clicking on what button
Submit for Re-Eval
