Set a financial cap

Description:

A financial cap set is a monetary amount set by a insurance, typically Medicare, which limits the payment that insurance will reimburse for each patient in a calendar year. The cap amount can change each year with the announcement of the final rule and the amount will vary between different insurances. Whether a patient has a hard or a soft cap, the process within TheraOffice is the same.

This guide will explain how to enter this information, as well as how to change a fee schedule to a contracted fee schedule (KX) once the patient's cap has been hit.

Products Affected:

TheraOffice Onsite and Web

How to Enter:

There are two places where the financial cap should be entered into the patient's case. The insurance Verification of Benefits and Case Information: Reminders. Both of these sections can be accessed through the patient's Case Information.

VOB:

1. Go to the desired patient's Case Information.

2. After one is in the Case Information screen, click on the Payers tab to open the insurance information.

3. Once the insurance is added, click on the desired insurance to highlight it and then click on Verify Insurance.

4. This will bring up a screen in which the therapy cap can be entered. Enter both the total for the therapy cap and the Therapy Paid to Date fields. These will be used to calculate the total remaining.

The image above shows the VOB window with the Therapy Cap and Therapy Paid to Date fields highlighted in yellow.

5. Enter the information received from the insurance company and click on Save, then Close.

Reminders:

1. Navigate to the patient's Case Information and select the Reminders tab.

2. From here, the Financial Cap can be entered. Enter only the remaining amount.

The above image shows the Case Information with the Reminders tab selected and the Financial Cap highlighted in yellow.

3. Simply click on the ellipse and enter the cap.

Once the Cap is Reached:

1. Once the cap is reached, the box entitled "Cap Reached" should be check off within the Financial Cap section of the Reminders in the Case Information (see above).

The above image shows the Charges/Payments/Claim Form section with the Medicare KX fee schedule selected.

2. If the KX modifier will be needed going forward, you will change the Contracted Fee Schedule in the patient's cases to the appropriate fee schedule by navigating to the Charges / Payments / Claims Form section within the patient's Case Information.

• All new visits will be generate with the correct modifiers and fees associated with your KX fee schedule.