For Fee-for-Service (FFS) practices, using the correct fee for patient estimates is key. CareStack helps you use UCR (Usual, Customary, and Reasonable) fees instead of a lower Maximum Allowable fee to make accurate estimates. Let's see how to update your insurance plans in CareStack for better fee calculation.
Watch this video for a concise summary.
Let's get started!
To configure the insurance plan for fee estimation, perform the following:
Navigate to the System Menu > select Practice Settings > Insurance Manager > Plans.
Click Edit next to the intended insurance plan.
Under Fee Related Settings,
- Set Use UCR fees for Patient Fee Estimation as Yes.
- This calculates the patient estimate based on the UCR fee and the insurance estimate based on the coverages.
- Waiting period fees, maxed-out benefit fees, and non-covered code fees will also default to UCR fee and cannot be edited.
- Click Save to confirm. The UCR fee will now be used for patient fee estimation in the insurance plan.
Let's look at some examples below:
Scenario 1 |
If there are no deductibles in the plan, consider: UCR Fee = $100 Max Allowable = $60 Coverage = 40% Insurance Est = 40% of $60 = $24 → Patient Est = $76 |
| Scenario 2 |
If there are deductibles in the plan, consider: UCR Fee = $100 Max Allowable = $60 Coverage = 40% Deductible = $25 Insurance Est = 40% of ($60 - $25) = $14 → Patient Est = $86 ($100 - $14) |
Practices can use this article to enable and correctly use UCR fees for patient estimates, ensuring accurate calculations of the patient's cost.