About Insurance Contracts
The Contract dictionary in the System Administration module enables your organization to create and store contract terms for insurers with whom you do business. Contracts are specific to the Business EntityA Business Entity (BE) typically represents a unit of business within a given database. The business can be an Ambulatory Surgery Center (ASC), a physician's practice, an Anesthesia Billing unit, etc. Whether or not a BE is related to another BE within the same database is simply based on the business relationship between the two entities. They can be an ASC/Practice Management combination or an ASC/Anesthesia Billing combination, for example. BEs, whether related or not, typically have separate Federal Tax ID numbers. for which they are created. There is no sharing of contracts among Business Entities within a Business GroupA grouping of Business Entities that are "in business" with each other. These entities are usually owned by the same parent company or corporation. However, in some cases, they are separately owned, but they agree to share certain data across the Business Entities, so users do not need to continually re-enter patient data..
Contracts you create in the Contract dictionary are then associated to Insurance Plans in the Insurance Plan dictionary, which are then associated to Patients on the Insurance Policy screen in Demographics. One Contract can be assigned to one or more Insurance Plans.
Note: It is important to set appropriate security roles, so that only those staff members who are authorized to create contracts can edit the Contract dictionary.
The Contract Type you select will determine the default billing method (also known as billing type or reimbursement method) for procedures for a case. You can, however, select a different billing method for specific procedures. You can also select the default billing method for billable supplies/resources in the Contract dictionary and set a different billing method for specific supplies/resources.
- APCAmbulatory Payment Classification. Used for with Medicare contracts and contracts based on Medicare rates.
- Appended FeeA unique payment rate by procedure
- Capitated ContractAgreement between a Carrier and a Physician to receive a specified amount as payment for all covered services rendered during the contract period
- Fee GroupA common grouping of procedures all reimbursed at the same payment rate
- Flat Fee ContractOne set amount is paid for each procedure covered by the contract.
- Max Allowed Per Case ContractA contract is established that will pay a predetermined amount for all procedures done during that case.
- Max Allowed Per Visit ContractSimilar to the Max Allowed per Case option, but this will look to the Date of Service and apply the agreed upon rate at the DOS level.
- Percentage of Allowed ContractThe carrier will set an allowed amount for each covered procedure. The payment rate will be based on a percentage of the stated allowed amount.
- Percentage of Standard FeePayment will be made based on a specified percentage of the facility's standard fee. Example: 80% of standard fee.
Click the image to view a video describing the following topics in detail:
- Types of Insurance Contracts you can create in AmkaiOffice
- How to create a new contract
- How to associate a contract to an Insurance Carrier Plan
