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Sliding Fee Eligibility

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In myEvolv a sliding fee scale is used to adjust the amount to charge a client for services according to their income and number of dependents.

Details

A sliding fee scale shows what an individual's monthly liability will be depending on their calculated income. Clients are responsible for any service fees incurred up to their monthly liability. Once their liability is reached, the remaining services are billed to an entity such as a program at the county or state level.

Federal Poverty Guidelines are used in auto-calculating the specific percent of federal poverty-level guidelines and apply a discount or fee based on the percent score. This information can be used to determine a client's eligibility for coverage, such as a program at the state or county level.

A family or individual's recorded income is shown as a percentage against established guidelines, such as the Federal Poverty Guidelines. The agency establishes and applies rates and fees based on the client's income percentage in relation to the guidelines.

For example, a family of 5 has an income of $30,000, and the Federal Poverty Guidelines list an income of $28,410 for a family of 5. The calculation would be 30/28,410 = 1.0559 or 1.06% of the federal poverty level. Families with incomes between 100 and 200% of the federal poverty level would be charged some level of fees for services based on the agency-established rates based on the income percentage.

Setup

  • set up client and attach to a family
  • enter client's financial information for sliding fee scale calculation (Sliding Fee Eligibility form).
    • Information required to determine a client's eligibility includes the number of dependents, deductions, and income. 
  • Set the income level for the family
  • set up benefit assignment
  • set up claim deduction
  • add new plan rate
  • billing rate for encounter on the plan
  • attach sliding fee scale to client's benefit assignment

 

Sliding Fee Scale

set up sliding fee scale based off percentages for a service event

deduction percentage - calculated automatically; based on family size and income level (20244)

deduction percentages for a sliding fee scale

* the percentage of the event covered will default off the sliding fee scale

Sliding Fee Eligibility form

On the Sliding Fee Eligibility form you have two options for entering the client's income source.

  • Enter the income source one by one in the subform, which saves the information to the Income History table.

OR

  • Select the income override and hard code the dollar amount.

Individual entry

  1. Navigate to Client > Client Information > Personal Information > Sliding Fee Eligibility.
  2. Click Select Client and choose the client.
  3. In the Gross Monthly Income section, select the Use Detailed Income Sources check box.
  4. In the Enter Income Information grid, select the Is Primary check box if appropriate.
  5. Select the Income Source and enter the Amount.
  6. In the Yearly/Monthly, etc. column, select the time period for the income (bi-week, hour, month, and so on).
  7. Enter the Effective Date for the income source.
  8. In the taskbar click Save.

Patient Income

  1. Navigate to Client > Client Information > Personal Information > Sliding Fee Scale Eligibility.
  2. Click Select Client and choose the client.
  3. In the Household Information section, select the Use Detailed Collateral List check box if there is more than one household member.
  4. In the Other Household members grid
    1. In the Collateral column click the ellipses and search for and select a person living in the household.
    2. In the Relationship To column click the ellipses and select the person's relationship to the client.
    3. Select the Count As Household Member check box as appropriate.
    4. When finished, click Save. This auto-populates the Total Members From Collateral field with the number of collaterals that had the Count As Household Member check box selected plus the client.
  5. In the Gross Monthly Income section
    1. Select Use Detailed Income Sources if entering the income sources manually, one at a time.
      OR
    2. To override individual income sources, clear the Us Detailed Income Sources check box.
    3. With Use Detailed Income Sources selected, enter each source of income for the household.
    4. Family Size Override?
  6. Under Enter Income Information
    1. Select the Is Primary check box if the source is the primary income for the household.
    2. Select the applicable Income Source.
    3. Enter the amount. 
    4. Select the time period the income covers (yearly, weekly, monthly, and so on).
    5. Select the effective date for the income.
    6. Click Save. This auto-calculates the Total Current Yearly Income and populates this field. 
  7. Family Income Override??

Self Pay rates for Sliding Fee Scale

Specify programs to which a sliding fee scale will apply.

  1. Navigate to Finance Setup > Payer/Contract Setup > Self Pay Setup > Sliding Fee Scales.
  2. In the taskbar select New > Sliding Fee Scale.
  3. Enter a description, base income, and amount increase per person.
  4. Select the begin and end date for the sliding fee scale.
  5. Under Programs click the ellipses on the far right and select the program the sliding fee scale applies to. Repeat this step for each program that applies.
  6. For the Deduction Percentages enter the Percentage of Poverty From and Percentage of Poverty To. These percentages are _______________
    Note: The Percentage From cannot be greater than the Percentage To.
  7. For the Deduction Percent enter the percentage ____________________.
  8. In the taskbar click Save.

Misc.

Income override

  1. Navigate to Client > Client Information > Personal Information > Sliding Fee Eligibility.
  2. Click Select Client and choose the client.
  3. Select the Use Detailed Income Sources check box.
  4. Under Gross Monthly Income, select the Use Detailed Income Sources check box.
  5. In the Family Income Override field, enter the dollar amount.

Designate sliding fee scale at Patient Level

  1. Navigate to Client > Client Information > Personal Information > Benefit Assignments.
  2. Select or add Self Pay. 
  3. On the Claim Deduction Information tab, select Use Public Health Sliding Fee Scales.

Exempt service or rate from Sliding Fee Scale

  1. Navigate to Finance Setup > Payer/Contract Setup > Self Pay Setup > Plan - Rates Setup > Plan Setup Information.
  2. Select the plan.
  3. In the Billing Rates/Revenue section, select the Exempt from Sliding Fee Scale check box.
  4. Click Update.
  5. Click Save. 

Sliding Fee Scale and Claim processing

When a claim is generated, the system looks at the service fee, then the benefit assignment, to apply any deductions for the client.

Claim Details Report - amounts

  • bill the county for services in excess of the client's monthly liability
  • first-party billing statement

Reports

see the percentage a patient will pay or the percentage discount on services (Client Sliding Fee Eligibility)

includes sliding fee scale calculations (Patient Statement - from myInsight)

 

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