About Billing Architecture in myAvatar
Prior to creating a bill, it is helpful to understand how revenue and liability are generated in the system.
First, revenue is associated to a Revenue Reporting Group (RRG) based on program of service.
Then, liability is associated to a Financial Class based on the Guarantor and Benefit Plan for the service provided.
- Programs are associated to a client at Admission and can be modified at service entry.
- Guarantors are associated to a client in Financial Eligibility.
- Benefit Plans define which Covered Charge Categories are covered and other factors such as deductibles, co-pays, daily maximums, and the Practitioner Categories required for coverage. The Benefit Plan can be customized in Financial Eligibility.
- Practitioners are associated to a Practitioner Category which can be used in a Benefit Plan to determine coverage.
Service Codes are associated to a Covered Charge Category. Services are entered into the system through the posting of appointments, compiling inpatient charges, charge entry, or the input of progress notes. The amount of liability distributed to guarantors is based on Service Fee/Cross Reference Maintenance which cross references the service code, program, guarantor, and practitioner category to determine the fee for the service rendered. Other factors such as client age can also be used if the need arises.
Once a service is posted and the liability assigned to the client ledger, bill production can begin.
Much of the billing setup, such as RRGs, Financial Classes, Charge Categories and so on are set up by your system administrator. Additionally, Program Maintenance, Service Codes, and Service Fee/Cross Reference Maintenance, Guarantors and Practitioners, are usually set up by advanced billers. The setup in your system will vary from the myAvatar training environment based on the types of services your organization provides.
