Determining Patient Responsibility

To determine patient responsibility, the Rules Engine runs a pre-appointment telemedicine specific eligibility and benefits check. Then, once the appointment is completed, the payment collection screen is displayed.

The Rules Engine determines the copayment based on the information it receives from payers. As illustrated below, the Rules Engine identifies the appropriate copayment and auto-populates the amount in the payment collection form.

Click the “Show Insurance Details” link to view the copayment, coinsurance, deductible, and out-of-pocket amounts:

To edit an auto populated copayment, simply hover over the amount and click “edit”

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Patient responsibility-deductible met

The Rules Engine calculates coinsurance amounts using the eligibility and benefits information obtained from the payer. As you will notice below, the practice set the rate at $125. The Rules Engine multiplies the rate ($125) times the percentage of the coinsurance (.30 or 30%) to determine the coinsurance amount.

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High Deductible Plans/Deductibles

The platform allows the user to enter a custom amount whenever the patient’s deductible is not met. The user has the option to enter the provider’s contracted rate (for the particular payer), or the user can choose to bill the patient at a later time by clicking “Skip this step.”

The absence of a copay is a good indicator of a high deductible plan. High deductible plans are treated just like appointments in which the deductible is not met.

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The self-pay payment collection prompt comes up at the end of the appointment, much like a self-pay charge would in a regular office setting. The example below illustrates how the platform  prompts the provider to select one of the pre-loaded self-pay rates at the end of each appointment.  

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If none of the pre-loaded amounts are appropriate, the provider has the option to select a “custom amount"  

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Skip this step 

The "skip this step" link allows the provider to bypass the charge screen. After "Skip this step" is selected, the appointment will fall into a queue that can be accessed through the Billing Details portion of the platform. We recommend having the billing staff review the queue. 

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