Billing›Goods and Services (Cost Sharing / Copay Model)

Goods and Services (Cost Sharing / Copay Model)

Overview

The Goods and Services functionality in Ankota can be used to manage unique goods or services that require a special budget or payment management.

Cost sharing, a form of copayment, is a situation where the client must pay a copayment per month up front, usually each month for the year at a regular rate. The amount may change at the start of each year. (This is common in Georgia.) They then bill the rest to the state. The Goods and Services module can be used for this payment management as well.

This article includes:

  • Understanding Goods and Services
  • Authorizations
  • Creating the Invoice
  • Billing
  • Processing Payment

Understanding Goods and Services

The fundamental process begins with the visit category for a Good, Service, Cost Sharing, or Copay being built. Then a visit type is set up and associated with that visit type category. Then the main menu module, typically named Goods and Services but also potentially named Cost Sharing or Copay, is turned on in the Main Menu at left.

Then under the main menu access, the client is assigned an authorization for the visit type. (This authorization can also be made on the client's profile under the Authorize Units tab.) With that authorization in place, click Create a Payment (which in this case is really to create a visit, in order to request a payment), which actually creates a visit with a billable dollar amount, which can be sent to the client.

Authorizations

This authorization can be entered either on the client's individual Authorize Units tab in their client profile, or it can be added via Goods and Services.

To add the authorization via the Goods and Services module:

  1. Click Copay Management in the left Main Menu.
  2. Enter the client's name, then click Search Client. If you already have the authorization, skip to the next step.
  3. Click the Add New button under Authorize Services.
  4. Add the authorization, working top to bottom. This can be entered on a monthly basis, or enter the yearly amount and then create the monthly invoice as needed.
    • Admission ID is not necessary.
    • Be sure to enter the Type as an amount.

The Copay Management Add Authorization dialog displays form fields for entering authorization details including date range (9/23/2021 to 09/30/2021), notes, visit type and category (both set to COPAY CCSP), authorization number (1234), admission ID, and transaction type (Amount). The Rules section below shows time period, authorize units/amount, and warning only settings with an Add Rule button.

Creating the Invoice

To create an invoice, again use the Goods and Services system. This functionality allows creation of an invoice for an associated authorized copay at the click of a button.

To create the copay invoice:

  1. Click Goods and Services (or Cost Sharing/Copay) in the left Main Menu.
  2. Enter the client's name, then click the Search Clients with Authorized Units button.
  3. On the specific authorization, click Add Payment.

The Goods and Services page displays client selection fields and an "Authorize Services" section with a table showing authorized services for the selected client "TEST CLIENT". The table includes columns for Department, Start Date, End Date, Service Type, Authorized $$$, Remaining $$$, Edit, Delete, and Add Payment buttons, with one ABC department entry visible showing a COPAY CCSP service authorized for $300.00.

  1. Enter the date, description, and amount (leave Service Code as defaulted).
    • The dollar amount must be entered as a whole number (10, not $100.00).

A form showing claim details for the selected department MDC-ATL, with fields for Date (09/27/2021), Service Code (COPAY CCSP), Description ($100 copay), and Amount (100).

This will create a transaction history on this page, and a billable visit on the Calculate Billing/Payroll page (operation: Billing).

Billing

Once the visit has been created, proceed through the usual billing processes (Calculate Billing, then approve the draft on the Billing Report page).

NOTE: For customers with MCOs, the payer descriptor on the Copay visits must be changed to Private Pay. Otherwise, it will bill the copay to the payer descriptor at this time. Development to come.

Once the invoice is created, the Email Invoice to Client button can be used to email the invoice. The client must have a valid email for this function to work. If this button is not already configured for your organization, this configuration can be requested.

Alternately, print and mail the paper invoice.

Processing Payment

When the check or other payment is received from the client, the best practice is to apply the payment to the invoices that were billed, typically through the Accounts Receivable screen.

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