OnSTAFF 2000
PAY PLAN MENU
Utility/Insurance/Pay Plan/DIAGNOSIS
The Diagnosis option is used in adding and maintaining capitated contract information. This option allows you to carve out as fee for service all posted charges related to a diagnosis (i.e., allows you to override the /Utility/Procedure <HMO Adjust> field entry of N, thus flagging a procedure as fee for service, as if HMO Adjust was X. In order to use this feature the /Utility/Insurance/Pay Plan/Pay Plan <Carve Out> field must be set to D or B.
Menu Options:
Add Add a new Diagnosis carve out.
Modify Modify an existing Diagnosis carve out.
View View existing Diagnosis carve out.
Delete Delete an existing Diagnosis carve out.
Copy Copy an existing Diagnosis carve out.
Exit Exit returns you to the Pay Plan Menu.
When the Add option is selected, On-Staff will display the following fields:
Pay Plan: Enter the code of the existing pay plan. After pressing [Enter], the name of the pay plan will display in the Description column and the cursor will advance to the Pay Plan column.
Diagnosis: Enter the code of the diagnosis (/Utility/Diagnosis <Diagnosis Code>) which is to be carved out by this pay plan. After pressing [Enter] the diagnosis will display in the Description column and the cursor will advance to the Pay Plan column.
At this point you may either Add, Modify, or Delete contractual diagnosis carve out information or press the [“] or [End] key to move the cursor to the CMD (command) column. By pressing Q or [End] from the CMD (command) column, On-Staff will return to the /Pay Plan/Diagnosis Menu.
When posting charges, On-Staff will check the New Patient Insurance screen Pay Plan field for a plan code entry. If found, that pay plan screen’s Carve Out field is checked for a field entry.
a) When D is found, the /Pay Plan/Diagnosis screen is checked for the pay plan and diagnosis code. If one or more of the posted diagnosis(ses) is (are) found, On-Staff will flag all charges during that charge session as fee for service.
b) When P is found, the /Pay Plan/Procedure screen is checked for the pay plan and procedure code. If found, On-Staff will flag that procedure as fee for service.
c) When B is found, BOTH the /Pay Plan/Diagnosis AND /Pay Plan/Procedure screens are checked as noted in a) and b) above.
When none of the charge screen’s diagnosis or procedures are found, On-Staff will flag all charges per the /Utility/Procedure <HMO Adjust> field entry.
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