OfficeMate Home Office User's Guide - OfficeMate Software Solutions

Setting Up Plan Detailed Benefits
Chapter 2 Setting Up Insurance Carriers & Plans
Set the sequence in which products and services are paid under the plan by
typing a number (between 1 and 5) in the Discount, Out of Pocket, Co-Pay,
T/P Reimbursement, and Balance fields.
Notes
• This is where you account for 100% of the product and service
fees. All the fees charged by the practice will fall into these five
categories: discount, patient out of pocket, copay, insurance
reimbursement, and balance write off.
• Enter the number in which each category should be executed in
the sequence and type each number only once. For example, if
the patient’s copay must be covered before any other
calculations, type 1 in the Co-Pay field. If a discount must be
applied to the entire balance before the copay is deducted from
the total, type 1 in the Discount field and type 2 in the Co-Pay
field.
• Discount must be first in the sequence or last in the sequence
depending on whether the discount is to be applied before or
after.
• Co-Pay must precede T/P Reimbursement in the sequence.
For the Discount category, perform the following steps:
a. Select the Before radio button if a discount should be applied to the
balance before the patient payment or select the After radio button if a
discount should be applied after the patient payment.
b. Select the $ Amt radio button if the discount is a dollar amount or select
the % Amt radio button if the discount is a percent.
c. Type the amount or percent of the discount.
For the Out of Pocket category, perform the following steps:
a. Select the $ Amt, % Amt, Benefit, or Balance radio button depending
on the insurance plan’s patient benefit.
Notes
• The dollar and percentage amounts are amounts that may be
specified by the insurance plan.
• The Benefit amount is the patient’s allowance. The patient is
responsible for any amount above the benefit amount.
• The Balance radio button indicates that the patient is
responsible for any amount above the third party
reimbursement.
• If you select the Balance radio button, the Out of Pocket
category must be last in the sequence. Type 4 for the Out of
Pocket sequence number and leave the Balance category blank.
b. Type the amount or percent of the discount or type the amount of the
patient’s benefit.
154 OfficeMate Home Office User’s Guide