Rules-Based System
EHS uses a rules-based engine when calculating sliding fees, which is completely customizable for individual FQHCs and CHCs. The rules method was designed to provide much greater flexibility, so that the system can evaluate multiple formulas to determine the proper calculation and allow for different sliding fees based on the particular scope of services.
Multiple Criteria
When building rules, multiple criteria can be used, such as the originating financial group, the provider doing the billing, the results of a household assessment, the CPT Group, or the actual CPT code. Rules can also carry different weights, which are used to determine which rule has the greatest effect in the final calculation.
Rules Application
Sliding Fee rules can be applied during charge entry or later as part of a batch run. During the batch run, CareRevolution takes into account any posted payments and determines the current account balance. Rules are brought into play on patient-responsible balances after insurance payments have been posted if the patient qualifies for sliding fees.
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