The New Copay Paradigm (NCP) is designed to manage patient responsibility amounts based on their insurance policy. Unlike the legacy method, NCP includes fields for co-insurance and takes allowed amounts from fee schedules into consideration.
Legacy Method Limitations
The legacy method includes:
Number of visits toward deductible and dollar amount toward patient responsibility
Number of visits toward copay and dollar amount toward patient responsibility
Max visits
It does not include a section for co-insurance and does not consider allowed amounts from fee schedules.
New Copay Paradigm Features
The NCP offers a more comprehensive approach by including fields for:
Remaining deductible
Number of visits toward copay and dollar amount toward patient responsibility
Co-insurance percentage toward patient responsibility
Max visits
It also considers allowed amounts from fee schedules.
Field Descriptions -
A. Remaining Deductible
Purpose: Enter the amount the patient has remaining to meet their deductible after performing an eligibility check.
Important Note: This amount does not automatically adjust as services are added to the ledger; it must be manually updated. If an EOB indicates that a patient has met their deductible, remove the remaining deductible amount to enable the co-insurance percentage.
Fee Schedule: If attached, the allowed amount is applied to the deductible column. Without it, the full charge amount is applied.
B. Copay
Purpose: Specify the number of visits where the copay will apply toward patient responsibility.
C. Co-insurance %
Purpose: Enter the patient’s co-insurance percentage (e.g., for an 80/20 split, enter 20).
Fee Schedule: If attached, the patient’s percentage is calculated based on the allowed amount. Without it, the full charge amount is used.
D. Max Visits
Purpose: Enter the total number of visits allowed based on the patient’s policy.
Notification: Once max visits are reached, a message will appear on the SOAP notes screen. It is recommended to set up an alert for the front desk as well.
Tracking: The "Max Visits" field references the patient's ledger and counts any service categorized under "Chiropractic" in the Tracking/Reporting tab. To access this, go to:
Path: System Dashboard > System Settings > System Configuration > Tracking/Reporting > Chiropractic.
Automation: After max visits are reached, the system will set subsequent services to be fully patient responsibility, excluding them from the billing queue.
NCP Setting Location:
Path: Location > Settings > Office > Office Configuration > New Copay Paradigm
Additional Notes
The amounts applied as patient responsibility in the deductible, copay, or co-insurance columns on the ledger are not visible on claims. These distinctions help with posting EOBs and predicting patient responsibility. The EOB is the final judgment on what a patient owes.