TOSR:  Time of Service Reduction

For more information about time of service reduction, please visit article on TOSR below in this page.

Editing patient receipts

To edit the patient receipt template:

1. Goto Start->Programs->Software Motif->SmartPad Template Editor
2. In the SmartPad Template Editor, open C:\Program Files\Chirosoft\Data\Common\Documents\receipt.txm
3. Edit the receipt as desired for the receipt message, or delete it entirely, including the frames.
4. Save the newly edited receipt template.

Macros:  Auto-checkout and On-demand

Macros are a set of several CPT codes, but can contain only one CPT code.  Macros are used for 2 purposes:

1)  On-demand macros on the transaction window, used to select macros and choose "Apply" as in the figures below.

2)  Auto-Checkout macros are the same macros that are automatically used during the appointment checkout process.  These are the same macros with the same CPT codes that are used. 

The Auto-Checkout macros function by examining the MyEMR treatment plan record to inspect which modalities the doctor performed.  These modalities are themselves the macro names.  So, a doctor choosing his treatment plan is actually choosing the macros.  The appointment auto-checkout looks at these values and automatically inserts the CPT codes associated with the doctor's treatment plan, equivalent to macros.

Setting up macros

To setup macros, from either EMR Datacenter or MyEMR for Window, go to:

     Tools->Catalogs->Procedures->Macros

You will see the figure below:

Choose the treatment macro in the upper left hand window, then choose CPT codes in the right window to associate the CPT codes with the modality.  You will see them summarized below, in the listbox labeled "Procedures in Macro".

You should associate verbiage for newly created macros that the treating physician will use for selection in MyEMR.  Choose the "Verbiage" button to add synonyms and goals that will be used by the random text generation engine.

MyEMR modality and EMR Datacenter macros

The treatment plan modalities customization from within MyEMR's Tools->Customize->Plan->Modalities window supports strict coordination between the visibility of MyEMR modalities and the EMR Datacenter macros.

Suppressing the visbility of a MyEMR modality will suppress the corresponding macro in EMR Datacenter.

Choosing "Retrieve Deleted" in the customize area of MyEMR will recover all invisible (psuedo-deleted) modalities and macros.

TOSR:  Time of Service Reduction

Time of service reduction ("TOSR") is a method of discounting services that does not discriminate against any person or responsible party in a healthcare provider office.

If services are paid at the time of service, a discount is appropriate since there will not be the administrative costs of billing and collecting the services, or the losses incurred through insurance (or discount plan) denials that, although candidates for administrative appeal with merit, the administrative costs outweigh appealing most services that are denied.

Accordingly, if a patient pays at time of service, it is fair to offer them a reasonable discount, proportional to your administrative collection fees, plus an incentive for a patient to pay at time of service.

This is non-discriminatory, because if an insurance adjuster was at the office with the company checkbook as their insured party checked-out, you would offer them the same TOSR discount.  (Don't count on this.)

EMR Datacenter supports TOSR through the Tools->Procedure Catalog.  For each service or product entry, the TOSR amount is the reduction.  For example, if you charge $45 for an adjustment, but fairly assess your administrative payroll and other costs to collect the $45 as $8, then it is fair to implement the $8 TOSR discount.  Similarly, if hot packs are $20, but the patient is willing to pay at the time of service, a fair TOSR discount may be $6. 

The rule is that your TOSR discount is reasonable and prudent.  The TOSR discounting method is not intended for hardship or charity cases, but the norm of your healthcare transactions.

Once you have decided your TOSR discount amounts and set them in Tools->Catalogs->Procedures, the TOSR discounts are ready to be implemented.  On the New Transaction window, if the front desk person asks if the patient will be paying in full today, their "time of service discount" applies, so the TOSR button on the New Transaction window is pressed which applies the *TOSR discount to each transaction.  (If a patient is able to pay some but not services at the time of service, the *TOSR must be deleted for transactions that will be billed – this is the "spirit" and also the legal argument of the TOSR discount.)

In real world situations, where insurance assignment is being accepted, the insurance companies will never receive the TOSR discount, because the insurance responsibility is assigned and billed.  But if a patient has an insurance policy and you are not accepting assignment on the insurance, you do not have the administrative costs of billing so the patient should be able to qualify for the discount.  You should seek legal advice in your state regarding the patient receiving a discount and their ability to receive proportional reimbursement when filing their own insurance.

Prepaid Wellness Care Plans and Group Discount Plans

Prepayment escrow plans are great for office, with emphasis that the legal agreement be construed such that the healthcare provider is not practicing insurance without a license. 

Once again, since there is not the administrative cost of collecting the payment, this substantiates a reduced amount for the term of the escrow pre-payment, pursuant to a well constructed legal agreement.  Before constructing any pre-payment escrow plan, you should check with a legal advisor who specializes in Healthcare Law in your state, or with your state's chiropractic association.

Group discount plans aren't themselves insurance companies, but rather are constructed to offer discounts for chiropractic, dental and other heathcare services.  These patients are essentially cash patients who qualify for a discount negotiated by the group discount plan.  These discounts should be entered as simple patient credit memos, or new patient credit memo entries can be created so that practice statistics can total the amount for each group discount plan.

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