What is the purpose of the article?
This article will:-
- Provide a high-level overview of the different Billing Rules
- Work through the list of Billing Rules in the order as seen in your chamber.
- Help you understand the functionality of each billing rule and how they can be saved, applied and reused, to create various scenarios.
Contents
Benefit Maxima Percentage Rule
The Billing Rules
Billing Rules are sets of pricing rules such as those for appointments and services, cancellations, fee percentages and online bookings. They are combined in Chargebands to control the services and prices available when bookings are made.
Billing Rules can be:
- Accessed via Start Page > Admin > Billing Rules.
- Added via Start Page > Admin > Billing Rules > [Select Company] > + Add Rule.
Chargeband
A Chargeband is a container for sets of rules that define the pricing and eligibility for services for a patient.
There are some Charge Band characteristics that are set separately from the Rules. These include its
- Debtor type (patient, or company on behalf of patient),
- Age from
- The ability to enable online booking
- The ability to enable membership.
Chargebands can be:
- Applied for each patient record and company record. This can be 'default'.
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Chargeband.
- Applied for patient via ... Patient Record > Personal Details.
Rule Set
A method of combining different sets of Billing Rules to a group. The Rule Set itself can then be applied to a Charge band.
Where there are many different rules that may need to be applied for different companies, a Rule Set can be a useful mechanism of grouping rules together to ensure they are applied consistently.
A Rule Set can be:
- Created via Start Page > Admin > Billing Rules > + Add rule > New Rule Set.
Price List
A set of prices for appointment types and services. A Price List can be configured so that it only applies when there is a specific doctor/role, at a specific site, at a location. Alternatively, the Price List can be left to apply in 'Any...' context.
Additionally, a Price List can either provide any service with a price, or rely on other rules to Provide services. This can be controlled through the 'Provide services with prices?' flag.
When created, a Price List can be added as a Rule to a Charge Band; after which it is available for pricing services for patients.
A price list can be:
- Created via Start Page > Admin > Billing Rules > + Add rule > Add New Price List.
- Added to Charge Band via Start Page > Admin Billing Rule > [Select] Charge Band > + Add Rule.
Benefit Maxima Percentage Rule
Defines the maximum percentage of a bill that an insurer will pay. The remainder is billed to the patient.
This is set-up as a rule that can be applied to a Charge Band.
A Benefit Maxima Percentage Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Benefit Maxima Percentage Rule.
Cancellation Charges Rule
A Billing Rule that defines the conditions of when a Cancellation fee will be applied for an appointment. The conditions could be the type of cancellation (cancellation, DNA, rescheduled) or the notice period. It also enables the definition of:-
- The payer (default payer or the patient)
- Whether the fee is a percentage of the bill or a fixed amount
- Conditions of when it applies (e.g. Doctor/role, site, location)
A Cancellation Charges Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Cancellation Charges Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Deny Services Rule
A Billing Rule that prevents different types of services being accessed by patients allocated to a specific Charge Band. This can be applied only when certain criteria are met. Namely Doctor/Role, Site, Location and/or Tag.
A Deny Services Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Deny Services Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Dynamic Price Rule
A Billing Rule that enables banded pricing for slots depending on how many remaining slots there are available in a Clinician's diary for the day.
In practice this may be used to charge less when there are more slots available and conversely charge more when there are fewer slots available.
A Dynamic Price Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Dynamic Price Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Fee Percent Rule
A Billing Rule that enables a percentage based fee split with a Billing Company. This could be a Clinician's Billing company or another specified Billing Company.
This is typically used where the Clinic and the Clinician agree a percentage based fee split for the delivered services.
In this scenario, there will be invoice where the payer/patient is the debtor. But also another invoice where the company is the debtor and the other specified Billing Company is the creditor.
A Fee Percentage Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Fee Percent Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Fee Rule
A Billing Rule that enables a fixed fee allocation to another Billing Company. The other Billing Company receives a fixed amount irrespective of the invoice total.
This is typically used if a clinician charges a fixed fee for performing a service. The Fee Rule can be set to only apply under certain conditions. For example for a specific Doctor/Role, site, location and/or tags.
In this scenario, there will be an invoice where the payer/patient is the debtor. But also another invoice where the company is the debtor and the other specified Billing Company is the creditor.
A Fee Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Fee Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Invoice Grouping Rule
A Billing Rule that enables the allocation of services to different invoices, and potentially different billing companies, depending on the Invoice Group applied.
An Invoice Grouping Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Invoice Group Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Multiple Procedure Rule
A Billing Rule that enables the application of a discount for multiple services. This can be applied as a percentage discount to the price of the second service or consequent services using 'Service Price %'. The first service is charged at 100%.
Alternatively it can be calculated using the price of the 'Highest Value Service' and calculating consequent services as a percentage supplement of that original service price.
A Multiple Procedure Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Multiple Procedure Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Patient Self-Book Rule
A rule that, when applied to a Charge band, enables patients to self-book selected services on the Patient Portal.
Please note - This requires the customer to have the Patient Portal chargeable feature activated, the Portal configured for use and the related Charge Band enabled for online bookings.
A Patient Self-Book Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Patient Self-Book Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule
Portal Referral Rule
A rule that defines whether referrers can refer patients and/or make bookings through the Referral Portal.
It also enables the definition of a range of SLA settings for referral management such as the number of days to make contact and the number of days to finish a report.
Beyond that, the rule enables the definition of the services to which the SLA applies.
A Portal Referral Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Portal Referral Rule.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Additionally, a Portal Referral Rule is only relevant where
- The Referral Portal is enabled via Admin > Configuration > Chargeable feature > Occupational Health Portal
- The pre-requisite set-up and configuration has been carried out
Price List Modifier Rule
A Billing Rule that enables the modification of a price list by a specified percentage. Either for the total price charged or in the context of Benefit Maxima.
It can also be set to apply under 'any' conditions for a Charge band; or only applied for a specific doctor/role, site, location and/or tag.
A Price List Modifier Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add Rule > New Price List Modifier Rule.
Provide Services Rule
A Billing Rule that works with Price Lists on a Charge Band. When 'Provide services with prices' is not ticked for a Price List, this rule can be used to define what services are available under different conditions.
A Provide Services Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add rule > New Provide Services Rules.
- Added to Charge Band via Start Page > Admin Billing Rules > [Select] Charge Band > + Add Rule.
Safe Name Rule
Enables the application of 'Safe Names' (alternative names) for services that are presented on Invoices.
As an example a 'Hepatitis Test' could have a 'Safe Name' of 'Medical Test'. This name 'Medical Test' would then appear on the invoice.
A Safe Name Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add rule > Add New Price List.
- Alternatively created via Start Page > Admin > Service Management.
- Viewed when the user produces an invoice for service(s).
Service Credits Rule
A rule that enables the restriction of the number of times a service can be applied for a patient in a time period.
A Service Credits Rule can be:
- Created via Start Page > Admin > Billing Rules > + Add rule > New Service Credits Rule.
Review date
This article was last updated on 1 July 2021 in the context of Meddbase version 1.245.0.31828