PCP Simple View
Posted by Carlos Ramos on 21 Oct 2011 09:26 AM

The New Simple View

  You may have noticed that the Order/Modify Item (frame, lens, service) screen in MVE version 10 has changed and a new view has been added to simplify calculations. This new feature is enabled for each insurance company in the Insurance setup screen (File > Setup > Insurance) by checking the ‘PCP Simple View’checkbox.

 

  Without PCP Simple View, you need to know the allowances and chargebacks for each plan. Ideally, you configure these in the Insurance Plan Fee Schedulesscreen. However, for some insurance companies and plans, this is not a practical approach. Although you can always enter the insurance benefits and fees manually for each order item, this may be cumbersome if PCP Simple View is not enabled for the insurance company selected for the order.

  The simple view provides the three essential pricing components for a sales item: the Patient Pays, the Insurance Pays and the Discount amount/type. These will add up to the entire retail charge of the procedure code for an item and will balance each other out whenever one is adjusted.

  In short, the PCP Simple View will work well for those insurance companies whose plans’ lens options cannot be easily priced in the Insurance Plan Fees Schedule screen. You should setup at least one insurance plan per company, even if you do not price the lens options in the corresponding fee schedule(s). This allows you to specify the allowances and copays for individual patients.

  NOTE: Some customers used the ‘Insurance Supplied’ view in version 9.52 of MVE to make it easier to calculate Patient Pays and Insurance Pays amounts. This was not the intended functionality for the ‘Insurance Supplied’ option and changes were made in version 10.0 to restrict its use accordingly.

Using PCP Simple View

  If insurance benefits have been authorized for the patient, you can specify what they are in the patient profile. The patient profile can be accessed directly from Quick Order by using the Details… button at the top right of the screen.

 

  What follows is the procedure to price a spectacle lens order using PCP Simple View after you have selected the patient profile and entered the authorization of benefits information:

1.     Select the lenses.

2.     Select the lens treatments.

3.     Select the frame.

NOTE: The frame allowance is added automatically to the order if you set it up as part of the authorization.

4.     Select the ‘Insurance’ company and ‘Plan’.

5.     Select the authorization number.

6.     Double-click on each item affected by insurance and apply the ‘Amt’‘Percent’, or retail % ‘Discount’. The ‘Pat Pays’ column is calculated automatically and the balance goes to ‘Ins Pay’. Examination items send the entire fee to ‘Pat Pay’, so enter the correct ‘Pat Pay’ and the balance will go to ‘Ins Pay’.  Discounts are rare but will go to the ‘Discount’ column.

  NOTE: For lenses, the system assumes full coverage and assigns the Retail amount to ‘Discount’ rather than ‘Ins Pays’ since the insurance fee schedule has not been priced.  Enter zero under ‘Patient Pays’, to correct this and the ‘Ins Pays’ and ‘Discount’ amount will be adjusted accordingly.

 

  There will be no allowances in the ‘Discount’ column if you follow the above procedures.  All ‘Ins Pays’ are accounted for as shown. Patient and insurance ledgers will be correct.

 

Simple View Balancing

Below shows a simple example of what to expect from the simple view balancing:

1.     For a V2020 Frame charge of $299.95, the responsibility of the total charge will be applied to the patient unless an allowance is entered in the insurance fee schedule or in the patient profile.

 

2.     Adjusting the patient pays amount will place the difference to the ‘Ins Pays’. For instance, correcting the patient pays to $200.00 will result in an insurance pays of $99.95.

 

3.     Adjusting the ‘Ins Pays’ amount will place the difference into ‘Discount’. In this example, adjusting the ‘Ins Pays’ to $50.00 will place a fixed amount of $49.95 into ‘Discount’.

 

4.     Furthermore, adjusting the ‘Discount’ amount will place the remaining balance back to the patient. In the example below, the ‘Discount’ was corrected to $40.00 from $49.95 resulting in the $9.95 difference to be added back to the patient. The user may adjust the ‘Type’ of discount as they wish; the "Amount" type discounts the retail by a set amount, "Percent" will discount a percentage of the patient overage and "Retail" will deduct a percent of the retail price.

 

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