This is an excellent example to demonstrate the use of adjustment codes. It
is important to remember the systems doesn't care how one names these codes.
The code names only need have meaning to you and your correspondents.
Below are just a few examples:
=========================
4 Employer Reduction
5 Not Approved
6 Lab Rejected
7 Additional Emp Payment
8 Professional Courtesy
=========================
These codes can be unlimited (1,000s) and represent insurance companies,
special employer arrangements, or special indigent categories such as
unemployed, disabled, or whatever applies to your population.
The added value of this system is the ease of adding cost accounting. Any
material or activity coat may be attached to the procedure. I don't want to
chew up a lot of bandwidth on this post, but will be glad to continue this
thread online of off line. Strongly advise understanding this concept before
adding complications to charges.
Example below- partial AR record: Notice the $62.03 write off (Adj)hopefully
format works...tx/t
===============================================
Company: XXXXXX COMPANYXXXXXXXXXX DOI:03/29/01
CHG SLIP # PATIENT DR
17065.0 PATIENT NAMEXXXXXX - 1006901 Pedigo
DOS DISCRIPTION AMT ADJUSTMENTS LINE BAL
032901 99203 - Office/outpa 110.00
043001 COMPANYXXXXX 8 -110.00 0
032901 73564 - X-ray exam o 118.00
043001 COMPANYXXXXX 8 -55.97 -62.03Ins Adj 0
032901 L1810 - KNEE SUPPORT 25.00
043001 COPANYXXXXX 8 -25.00 0
0.00
--------
TOTAL 0.00
> -----Original Message-----
> From: [EMAIL PROTECTED] [mailto:hardhats-
> [EMAIL PROTECTED] On Behalf Of Nick James
> Sent: Friday, February 04, 2005 10:48 PM
> To: hardhats-members@lists.sourceforge.net
> Subject: RE: [Hardhats-members] differential charging for diagnostic tests
>
> Hi Thurman,
>
> Thanks, that is certainly helpful.
>
> But the issues also relate to a categorisation of
> direct paying patients which includes free (only some
> select tests are free) subsidy, semi-subsidy, normal
> private and luxury provate. The hospital where we once
> worked for had six categories, each with differing
> charges for the same test. I suppose one could treat
> each category as a different employer using the same
> logic as in industrial billing. Please comment.
>
>
> --- Thurman Pedigo <[EMAIL PROTECTED]> wrote:
>
> > This is a little different philosophy that has
> > worked well for me over the
> > past 30 years.
> >
> > Billing for commercial insurance, Medicare, and
> > Medicaid, have no need for
> > "multiple rate" billing. Adjustments/write-offs,
> > bring the payments into
> > compliance with the charge and provides a powerful
> > tool to assess
> > performance in the accounts receivables.
> >
> > Industrial billing, where one contracts to with an
> > employer to do specific
> > services at a set price uses modification of the
> > last 2 characters in the
> > CPT code AND includes the company name in the
> > description.
> >
> > Thanks,
> >
> > thurman
> >
> >
> > > -----Original Message-----
> > > From: [EMAIL PROTECTED]
> > [mailto:hardhats-
> > > [EMAIL PROTECTED] On Behalf Of
> > Nancy Anthracite
> > > Sent: Friday, February 04, 2005 1:11 PM
> > > To: hardhats-members@lists.sourceforge.net
> > > Subject: Re: [Hardhats-members] differential
> > charging for diagnostic tests
> > >
> > > I believe the majority of the billing is not done
> > within VistA. The
> > > recent
> > > billing patches, to my knowledge, only gather
> > together information for a
> > > third party billing service to use to process a
> > claim, and it may not even
> > > include charges at all, as I believe that is
> > probably handled by the
> > > processing entity or information provided to that
> > entity separately. Even
> > > if
> > > there are charges withing VistA, I doubt there are
> > any rates that would
> > > differ from patient to patient.
> > >
> > > On Friday 04 February 2005 07:22 am, Nick James
> > wrote:
> > > > can multople rates be maintained by VistA?
> > > >
> > > > If the charges applicable for a test are to be
> > based
> > > > on the patient type, and multiple rates apply
> > for the
> > > > same test depending on the patient type.
> > > >
> > > > If so how is it defined and which file is it
> > stored in?
> > > >
> > > >
> > > >
> > > > __________________________________
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> > > >
> > > >
> >
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> > > --
> > > Nancy Anthracite
> > >
> > >
> > >
> >
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