What is the context?
Meddbase is a complex, multi-layered EMR system, capable of accommodating a wide variety of workflows and business models ranging from small practices, straightforward setup and only a couple of people using the application, through to global enterprises with thousands of users and nuanced workflows and business requirements.
Meddbase provides a high number of configuration options allowing the application to adapt to complex business scenarios, as well as a host of default settings that it can fall back on when complexity is minimal.
Meddbase can be and is used in Primary Care, Secondary Care as well as in Occupational Health.
What is the purpose of the article?
This article is the 3rd in a series of articles providing overview and details of setup and configuration steps required for Practice Management, which focuses on the application of the Meddbase system in Primary and Secondary Care.
Click here for Part 1.
Click here for Part 2.
Click here for Part 3.1.
Click here for Part 4.
Click here for Part 5.
This article will explain individual Billing Rule functionality and adding them to (a) Charge Band(s) as follows*:
*Click the below links to be taken to the respective section of the article
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- Rule set
- Benefit Maxima Percentage Rule
- Cancellation Charges Rule
- Deny Services Rule
- Dynamic Price Rule
- Fee Percent Rule
- Fee Rule
- Invoice Grouping Rule
- Multiple Procedure Rule
- Patient Portal Pathways Rule
- Patient Self-Book Rule
- Portal Referral Rule
- Price List Modifier Rule
- Safe Name Rule
- Service Credits Rule
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3. Adding Rules to a Charge Band and Rule priority
Overview
Choosing which rule to apply in your chamber’s billing rules depends on the bulling scenario you are trying to automate and the needs of your business.
As mentioned in Part 3.1 of this series, a company may conduct business in a straightforward manner, requiring a simple setup in their chamber with only 1 charge band for self-pay patients using only a pricelist or a provide services rule.
On the other hand, a given business may offer multiple service tiers and receive payments from various debtors, like employers, insurance companies etc. as well as patients. Furthermore, there may be requirements to automate other billing scenarios like cancellation or DNA charges or fee splits for self-employed consultants.
To that end, Meddbase provides a host of Billing Rules that can be added to Charge Bands in various combinations, depending on the scenario. We will discuss each rule individually in the order they are displayed in the system and highlight key relations between them as certain pairs of rules may be mutually exclusive.
Rule Types
Below you will find descriptions of individual rule types and explanations of their functionality in the order they are displayed when viewed in Admin > Billing Rules > +Add rule...
Click +Add rule and select the required rule from the list.
Rule set
A Rules Set serves as a container you can use to store multiple rules that have something in common, e.g., multiple pricelists, each applying at a different site, and subsequently add the entire Rule Set to a given Charge Band or Charge Bands respectively. This saves you the trouble of adding individual rules to each respective Charge Band and ensures you add the same set of rules each time.
Furthermore, you can limit the application of the entire rule set to a particular medical professional or role group, a given site and location at that site, and a particular clinician schedule sharing the same tag, which in turn saves you having to apply these settings to each of the rules in the rule set individually.
Click here for more details on Rule Sets.
Benefit Maxima Percentage Rule
This rule is added to charge bands belonging to 3rd party debtors paying on patients’ behalf, like employers or insurance companies and allows splitting the payment for consumed services between the 3rd party and the patient.
As mentioned in the previous video, when naming rules you can organise them into folders by adding the folder name/ in front of the rule name. Using a new folder name/ will create the folder and using an existing folder name/ will move the rule to that folder.
You can specify the circumstances under which the rule applies or leave it open. Clicking Show All in the Benefit Maxima section, and subsequently clicking Add in the appointment and service section, allows you to set the percentage of the service cost the 3rd party debtor will pay. The remainder of the service cost will be invoiced to the patient, e.g., if an Initial Consultation is £100 and the Benefit Maxima Percentage rule states 30% for that service, £30 will be invoiced to the 3rd party and £70 to the patient, assuming the 3rd party is the patient’s preferred payer.
Click here for more details on the Benefit Maxima Percentage Rule.
Cancellation Charges Rule
This rule can be added to any charge band where you would want automatic charges to be raised for a patient cancelling, not arriving for, or rescheduling an appointment.
Again, use folder name/ in front of the rule name to place it in a folder. The Cancellation Type dropdown allows selecting the type of event you wish to charge for, so patient either cancelled, did not arrive, or rescheduled the appointment.
The Notice Period field allows specifying the time window for the charge to be triggered within.
For Did Not Arrive cancellation type, the notice period is greyed out and doesn’t apply.
The Consider working days only checkbox allows excluding weekend cancellations, DNAs and rescheduling.
The Payer dropdown is by default set to Patient, meaning any charge triggered by this rule will be invoiced to the patient. You can change this setting to Preferred Payer and any charges will get invoiced to the respective 3rd party according to the patient’s preferred payer setup.
When it comes to the amount charged, it can be set as a Percentage of the bill, e.g., 50% of whatever the booked services cost, or a Fixed Value.
The Apply to all services? checkbox applies the rule to all appointment types when ticked. If this box is left unticked, you can apply this rule to specific appointment type in the Service Charges section.
The Refund Used Credits? Checkbox corresponds to another rule called Service Credits which will be discussed later in this video.
Again, you can specify the circumstances under which this rule applies.
Note that you can configure and add multiple Cancellation Charge Rules to a single Charge Band, e.g., 1 for cancellations, 2nd for DNAs and 3rd for Rescheduling to cover all scenarios. You could also create a rule set for the cancellation rules and add the rule set to the charge bands where it should apply.
Click here for more details on the Cancellation Charges Rule.
Deny Services Rule
This rule can be used to deny the availability of services on a given Charge Band when the Price List on that Charge Band has the Provide services with prices? Box ticked. Again, you can specify the circumstances under which the rule applies.
To reduce the number of clicks, you can either select the services you’d like to deny in the Services to Deny section or select the services you'd like to provide and tick Deny All, Except Ticked Services.
If the Deny Services Rule and the Provide Services Rule are added to the same Charge Band and they both apply to the same services, these services will be Denied.
Click here for more details on the Deny Services Rule.
Dynamic Price Rule
This rule can be added to a Charge Band if you wish to charge a different price for appointments and services depending on the number of free slots available on a clinician’s schedule.
You can specify which doctor or group, site and location and which schedule the rule applies to.
The Services to Provide section allows selecting the appointment types and services this rule will apply to.
The Price Bands sections allows you to specify maximum number or numbers of free slots available in a clinician’s session and the corresponding price.
Let’s use an example and define 3 Band Upper Slot Limits at 1, 2 and 3 and set the prices at 500, 400, 300 respectively and 200 for the default row. In this case, booking the last available slot on a clinician’s schedule costs 500, booking 1 of the last 2 available slots costs 400 and booking one of the last 3 available slots costs 300. If there are more than 3 available slots, the booking price is 200.
These prices override the prices set on a price list.
Click here for more details on the Dynamic Price Rule.
Fee Percent Rule
This rule can be added to a Charge Band where the doctor attending an appointment or a 3rd party act as the Billing Company and charge the chamber company a fee for attending an appointment.
For Self-employed doctors or Contractors, it may be beneficial to add a Billing Company for them to the system and select that company here.
That fee is calculated as a percentage of the cost of services consumed by the patient. You can set a Default Fee Percentage or specify different fee percentages for different appointments and services in the Service Fee Percentages section. If you specify both the Default Fee Percentage and specific Fee Percentages for some services at the same time, every service without a specific value will fall under the default fee percentage.
You can also specify which doctor or group, site, and location and which schedule the rule applies to.
Click here for more details on the Fee Percent Rule.
Fee Rule
Adding this rule to a charge band has an effect very similar to the Fee Percent Rule discussed above.
The difference is that here you define the charges paid to the attending doctor or 3rd party company as a fixed amount as opposed to a percentage of the bill. Furthermore, you have to set the values for services individually, as you can not set a default value to be applied to all of them.
Invoice Grouping Rule
Adding this rule to a charge band allows organising appointments and services into groups and split them into separate invoices when they get consumed whilst crediting those invoices to one or multiple internal companies.
This can be very useful when an umbrella company has internal subsidiaries that sometimes need to serve as creditors on invoices.
You can create as many invoice groups as you need and name them accordingly. Typically, that would be an acronym or abbreviation of the Billing Company name, but that is not mandatory.
Once you defined your groups and selected the respective billing company for every one of them, you can assign appointment types and services to the appropriate group.
In the Service Invoice Groups section click Show All, click Add for the required service type and type in the name of the group you would like to assign an individual service to.
You can also specify which doctor or group, site, and location and which schedule the rule applies to.
Click here for more details on the Invoice Grouping Rule.
Multiple Procedure Rule
Adding this rule to a Charge Band allows discounting procedures when more than 1 is added to an appointment booking.
The are 2 ways of discounting multiple procedures
The Highest Value Service option means the most expensive service out of the group added to an appointment will be charged at a 100% rate and depending on how many services get added in total, you can determine what percentage of the price of the most expensive service will be added.
Let’s use an example. 3 procedures cost £100, £50 and £25 respectively. And let’s say the % value for Two services is 25% of the highest value service and the % value for Three or more services is 10% of the highest value service.
This means in this example, that if you book 2 procedures, the less expensive one will be charged at 25% of the more expensive procedure’s price, or in practical terms, if you book the £100 and the £50 procedures, the £100 procedure will be charged in full and the other one will be charged as 25% of £100, so £125 in total for both.
If you book all 3 procedures, so the £100, the £50 and the £25 one, the £100 procedure will be charged in full and the charge for the other 2 in this example will be 10% of £100, so £100 in total for all 3 procedures.
The Service Price % on the other hand takes into account the hierarchy of prices, so if you put e.g. 25% in the second service field and say 15% in the further services field and book all 3 procedures, again the most expensive one will be charged in full, the second most expensive will be charged at 25% and any further, less expensive procedures will be charged at 15% and it does not matter in which order you add them to the appointment.
Click here for more details on the Multiple Procedure Rule.
Patient Portal Pathways Rule
When added to an online enabled Charge Band, this rule allows providing patients the ability to interact with Pathways via the Patient Portal.
The Maximum running pathways field allows setting the maximum number of instances of a specific pathway can run simultaneously at a given time.
The Provide Pathways section allows selecting the pathways you wish to provide on the Patient Portal
This rule allows utilising the Meddbase Pathways System on the Patient Portal. Pathways are highly customizable, custom workflows made up of a series of steps where actions are carried out and can therefore help solve business-specific problems. For more information on using Pathways in your system, please contact the Client Account Management team on: accountmanagement@meddbase.com
Click here for more details on understanding Pathways
Click here for more details on Patients interacting with Pathways.
Patient Self-Book Rule
Adding this rule to a Charge Band is part of a larger setup process enabling patients to book appointments vis the Patient Portal.
This rule by default allows patients to self-book the services selected in the Services Affected section. Click Show All and then click Add for the relevant service type. Tick the boxes for the services you wish to provide for online bookings.
The selected services first must be provided either via a Price List, a Provide Services Rule, or a Service Credits Rule.
You can also specify which doctor or group, site, and location and which schedule the rule applies to based on a shared tag.
Click here for more details on the Patient Portal setup.
Click here for more details on the Patient Self-Book Rule.
Portal Referral Rule
Adding this rule to a Charge Band is part of a larger setup process enabling 3rd party company managers to send referrals and/or book appointments via the Occupational Health Portal.
Utilising this rule is a part of a larger setup of Occupational Health workflows in Meddbase.
The Allow booking through the portal checkbox enables a workflow where a manager can make bookings via the OH Portal directly onto clinician schedules that allow online bookings.
The Allow referring through the portal checkbox enables a workflow where a manager can make referrals via the OH Portal generating an Incoming Referral work item including a referral letter.
The SLA policy section allows stating the Service Level Agreement details.
The Referral Contact Protocol dropdown allows selecting a custom Patient Contact Protocol, defined under Admin > Common Catalogues beforehand. A Contact Protocol is a suggested contact process for the recipient of the referral when any of the services are referred. Note that there is a default contact process for incoming referrals, so a custom protocol is optional.
The Days to make contact field allows stating the allowed number of days from receiving the referral to making a booking before an SLA is failed for the listed services. The reason for the SLA fail determines the consequences, e.g., if the OH Provider was unable to reach the patient, the SLA will fail, however the fault lies with the patient.
The Days to place an appointment field allows stating the allowed number of days from making a booking the appointment can start within, e.g., if 3 is entered here, that means the booked appointment start time must fall within the next 3 day, otherwise the SLA will fail. Again, the reason for the SLA fail determines the consequences, e.g., patient unable to attend appointment within the next 3 days is no fault of the OH Provider.
The Days to finish the report field allows stating the allowed number of days from appointment discharge to finishing and sending the OH Report to either the patient for review and authorisation or directly to the patient’s manager, depending on the setup.
The Days to review the report by patient online field displays the allowed number of days for the patient to review the report. Time is measured from the report being available to automatic release, less any non-working days or bank holidays.
The Days to review the report by patient manually field displays the allowed number of days for the patient to review the report when sent via a manual method, i.e., letter. Time is measured from the report being available to automatic release, less any non-working days or bank holidays. Note that this can be over-ridden at the time of report completion.
You can also specify which doctor or group, site, and location and which schedule the rule applies to based on a shared tag.
You can also specify Static or Dynamic date ranges. The rules surrounding applying date ranges are explained in detail in the Basic System Configuration Part 4 video.
Click here for Part 1 of the OH setup in Meddbase.
Click here for Part 2 of the OH setup in Meddbase.
Click here for Part 3 of the OH setup in Meddbase.
Click here for more details on the Portal Referral Rule.
Price List Modifier Rule
Adding this rule to a Charge Band allows increasing or decreasing all prices on an existing Price List by a specific %. This rule then serves as if it was a price list itself.
The Price List field allows you to select an existing pricelist that you wish to modify.
The Modify price % field allows you to define the % you wish to modify the price list by. Typing in either a whole or decimal number will increase prices by that percentage. Typing in a negative whole or decimal number will reduce prices by that percentage.
The Price Type dropdown is set to Total Charged Price by default. You can also select Benefit Maxima which allows you to set a maximum price for which this payer will pay. It is used in combination with a regular price list or another modifier rule serving as a pricelist, either with the Price Type set to Total Charged Price.
A Benefit Maxima payer type modifier rule is only valuable when used on a non-self pay charge band, e.g. employer or insurer charge band.
Consider the example below:
- An insurer Charge Band has a Benefit Maxima price list modifier rule, with a price of £50 for a given service. The same Charge Band also has a Total Charged Price price list, with a price of £200 for the same service. When this service is provided, two invoices will be raised as follows:
- Insurer Invoice: £50 (Taken from the Benefit Maxima price list)
- Patient Invoice: £150 (Total Charged Price - Benefit Maxima, £200 - £50)
The Total Charged Price and Benefit Maxima rules do not override one another, so can be in either order.
Click here for more details on the Price List Modifier Rule.
Safe Name Rule
Adding this rule to a Charge Band allows overriding appointment type and service names when displaying them on an invoice, e.g., a safe name for an STD test.
You can specify which doctor or group, site, and location and which schedule the rule applies to based on a shared tag.
The Service Safe Names section allows you to specify the safe names you wish to be displayed for appointment types and services when billing. Click Show All and click Add for the required service type. Type in the Safe Name for the relevant service. Typically, this would be an alphanumeric string, but you can use full names, acronyms, abbreviations, or number codes.
Click here for more details on the Safe Name Rule.
Service Credits Rule
When added to a Charge Band this rule serves as a temporary Provide Services Rule and should therefore not be used on the same Charge Band with an actual Provide Services Rule in relation to the same services.
Please note that the Charge Band you choose to add this rule to must also include a Price List defining the same appointment types and services and the Provide Services with prices? Box unticked or a Price List Modifier Rule modifying an existing price list with the same box unticked also.
If the credited appointments or services are meant to be provided free of charge, the Price List added to the Charge Band must state 0 as their price.
The First Included Day and First Excluded Day fields allow you to define the timeframe for this rule to apply within, e.g., from today until this time next year
You can also specify which doctor or group, site, and location and which schedule the rule applies to based on a shared tag.
The Services To Credit section allows you to add a number of credits to appointment types and services. Click Show All and then click Add for the required service type. Type a whole number of credits you wish to grant for the service.
When a patient consumes that service within the defined timeframe, the system will count down the remaining credits. Having used all available credits, the service will no longer be available to the patient.
You can also Enable periodic renewal.
The Unique start date per patient checkbox, when ticked, gives each patient their own rolling renewal period for the service credits, governed by when they were added to the charge band (for patients added to the charge band after the rules is enabled), or the date the rule was added to the charge band (for patients already on the charge band when the rule was added).
The Years, Months and Weeks fields allow defining the number of years, months, or weeks after the first excluded day when the service credits renew
Therefore, if Unique start date per patient is ticked, that means that every patient’s service credits renew X number of days/weeks/months after they were added to the charge band, rather than everyone's credits renewing on the same day.
Lastly, if the charge band this rule is added to also utilises a Cancellation Charges Rule, and an appointment is booked that had a certain number of credits, and this appointment is subsequently Cancelled, DNA’d or Rescheduled depending on the setup, the used credits can be refunded if the Refund used credits? Checkbox is ticked in the Cancellation Rule.
Click here for more details on the Service Credits Rule.
Adding rules to a Charge Band and Rule priority
As mentioned, multiple times in this series of articles on Billing Rules, to perform the desired action a rule must be added to a relevant Charge Band(s).
Charge Bands are linked to the entity or company they have been added under, so it can not be moved to another entity.
The same does not apply to the remainder of Billing Rules. Even though the entity owns the rule, it can be applied to multiple Charge Bands belonging to multiple entities.
This has a very practical benefit in that you don't have to create a duplicate rule for every entity, assuming the same rule with the same configuration is supposed to apply on multiple charge bands.
When adding rules to a charge band in its Rules section, you will notice that having added more than 1 rule you will have the ability to change the rue display order by dragging and dropping rules into position.
This feature allows organising rules on a charge band according to their application priority. The system will use the first applicable rule in a given scenario, checking the list of rules from top to bottom, so the narrower and more specific a given billing rule is, meaning it only applies when specific conditions are met, e.g., the booking is with a specific doctor at a specific site, the higher it should be on the display list.
Review date
This article was last updated on 22nd of Jan 2023 in the context of Meddbase version 1.264.1.14998