Sneak Peak – TheraOffice 2009.1.0.22 Patient Responsibility Estimator

Great cash flow and low accounts receivable balances are key to successful practices.  Government programs such as Medicare and Medicaid are reducing reimbursements and searching for overpayments while commercial insurers are also taking cue and doing the same.  For most practices, keeping ahead of the trends has been difficult and has tightening up cash flow.   TheraOffice’s technology is positioned to improve processes to increase revenue cycle management even as trends make it more difficult to maintain and grow your business.

Start With The Patient

We surveyed practices using TheraOffice and ZirMed and on average we found that clean claims were being processed by the payer in an average range 13-17 days.  The time however to turn around and send a statement to a patient for their balance could be several weeks, couple that with high deductible plans, increased coinsurance, and increased copays and a majority of your AR will be on the patient side.  We all know patient collections can be costly and difficult, especially in difficult economic, so more upfront “smaller” amounts seem to be more successful than a patient receiving an overwhelming bill.

In TheraOffice 2009.1.0.22, collection of deductible, copay, and co-insurance is simplified to increase front desk collection of patient responsibility.  TheraOffice utilizes payer algorithms to accurately estimate the patient responsibility to increase patient revenue capture while reducing the need to refund patients for overpayments.  TheraOffice Co-Insurance/Deductible Estimator is designed to improve upfront patient revenue collection while avoiding costly collection expenses on aged patient balances.  Your practice deserves to get paid for the high quality healthcare you provide, TheraOffice can help.

How it works?

At check in TheraOffice Scheduling will total the copay due and then estimate patient responsibility for the days visit.  This is then collected and applied to the visit.

  1. First TheraOffice will check if the patient has an active case, with insurance and that benefits have been verified with the network status set.   From the Verification of Benefits the Deductible, Current Deductible Paid, Therapy Cap, Therapy Paid to Date, and Co-Insurance amount will be used for the estimate.
  2. Next, TheraOffice will estimate an allowed amount for the visit.  This can be done 2 ways:
    1. By the charges from a previous visit.  EX: if the patient has been seen 5 times, then most likely the 6th visit will have similar charges as visits 2-5.  To estimate the allowed amount:
      1. First look to previous payments, coinsurance and deductibles in the patient’s active case.
      2. If not found in the active case then check in the patients other case(s) if available.
      3. If not found in the patients cases, then it will look for charges of other patients with the same insurance and charges and estimate the allowed amount.
      4. If not found in other patients, then TheraOffice will check if the insurance has a contracted fee schedule.  If so, then use the allowed amount from the contracted fee schedule if entered.
      5. If no contracted fee schedule then use the charge amount for the standard fee schedule.
    2. If the visit is the first visit in the case, then use a fixed amount that is set per discipline.  This fixed amount can be set in TheraOffice Administrator, and is a general allowed amount that is typical for the evaluation visit.
    3. If the visit is the second visit in the case, then use a fixed amount that is set per discipline.  This is done since the charges from visit #1 (which is typically the evaluation visit) will differ from visit #2.
  3. Next, TheraOffice will estimate responsibility for each allowed amount for each charge or for the entire visit based off the variables set in the Verification of Benefits.
  4. Finally total the responsibility for all charges.


The beginning of the year is a great time to review policy and procedures for all areas of the practice as well as collecting up front when deductibles haven’t been met.  When reviewing your policy for collections at the front desk, this new responsibility estimation tool can be implemented in one of the following ways:

  1. Collect the patient’s responsibility upfront for all patients for all insurances based on the estimation completed by TheraOffice.
  2. Collect the patient’s responsibility upfront for all patients with a given insurance and gradually phase in other insurances as allowed amounts become more accurate.
  3. Estimate patient’s responsibility but don’t apply the payments to the copays or patient responsibility.  Collect the payment once a week or another time frame and apply at once to all visits in the date range.

Video Demonstration

The below videos will demonstrate the new patient responsibility estimator in action.

Part 1 of 2