I will need to do some testing on this myself to see what is happening.
I may have some questions as to the steps you're taking. I'll ask here as needed. I'll start testing tomorrow (Tuesday) morning.
Just to make sure I'm understanding what you're expecting to happen.
When you're entering an insurance payment, you are updating the bluebook information and it's not updating the code specific estimating section for that plan correctly?
Or do you mean that once you distribute the payment and adjustment from this code, you want to know why it will not automatically apply the same distribution for that code in the future for all patient's on that plan?
I enter each line item payment, along with the corresponding adjustment. Then I click "update blue book". Then I go into code specific and make sure that each one is marked #4 and has the fixed amount posted (this is how it was done before I started working with this office). This is the first time I've worked with a plan that pays like this, so I'm wondering if the problem is that they are listing it as a fixed payment?
This is a definite YES. I posted 7 payments yesterday, all of them with the same plan, NONE of them populated the information that I had entered on any of the prior payments.
When patient method #4 is selected, it is only possible to use the Fixed amount of capitation/not covered option for insurance.
When you are updating the blue book when entering an IP entry that screen is currently designed to only have input to update the UCR and percentage options, which neither are available when using patient payment 4. Any information added to this screen will not update to the code-specific area for that code. However, while on the bluebook update screen there is a View button on the top right which will open the estimating screen for that plan where you can then go into the code specific and make the changes to the needed code(s). This information will carry over to any other patient's connected to that plan. That way when they have the same code used it will put in the correct amount expected for payment and the correct write off amount.
Now I did some testing with multiple patients having a claim opened with the same code on the same plan. I had my PPM set to 4 and fixed amount set to 50. once both were open and ready for payment I entered the first patient's IP and put in a payment of 65. I had to manually change the w/o amount before i could enter the distribution amount from the payment. I clicked on Update blue book > View > code-specific > changed the fixed amount for that code to 65 and then closed back down to finalize the payment entry.
I then went to the second patient and entered in an IP for its claim and saw that the numbers for the expected payment and write off did not update to the new information. I canceled the payment and went to the view/resubmit for that claim and clicked on the Re-estimate button and then it updated to the new numbers.
This seems to be by design. Mainly due to there being the possibility of claims open from the previous year/period on that plan. This way it won't update the expected estimating on those claims if they are actually supposed to estimate with the old numbers.
Does that seem to be more what you were seeing?
Yes - I was going in to "View" and updating each code. That is VERY inefficient for me to have to re-enter the same information for all the patients. I thought that was the primary purpose of the blue book - to have correct estimates for future services/claims? That would never be the case with this type of plan. There shouldn't be a need to click "re-estimate" on prior year's claims. I think I would be better off changing the plan to Patient payment method #1 and entering the amounts at 100% payment rate instead of #4 and fixed rate.
Interesting....I'm on my 5th payment for this plan today and I noticed that the w/o is showing for 2 of the procedures, but not the rest. I checked the code-specific details for each one - they are all set up exactly the same (#4 and a fixed amount). So I tried clicking "re-estimate" one one child's claim after I had just posted the sibling's payment (and updated the blue book). When I clicked re-estimate, one of the write-offs that had pre-populated previously was now GONE in the line item details!!!