The Line Item Limit tool lets you limit pricing of line items to a specific percentage of the billed charge. Limiting calculations to 100% of billed charges is typical for most contracts, but some providers may pay at a percentage that is less than billed charges.
This reimbursement tool compares the reimbursement value of all line items that have been repriced to the maximum reimbursement percentage you set in this tool. Repriced line items are defined as those line items with consumed units that are equal to or greater than the available units.
If a repriced line item reimbursement percentage is greater than the maximum reimbursement, this reimbursement tool changes the reimbursement value to the maximum percentage (the percentage defined in this tool multiplied by the charges for the line item).
- If a line item was repriced by another tool, and the reimbursement value exceeds the percentage in the Limit reimbursement to: % of charges field, the reimbursement percentage is changed to the percentage in this field.
- If a line item was repriced by another tool, and the reimbursement value does not exceed the percentage in the Limit reimbursement to: % of charges field, the reimbursement percentage is not changed.
Field Descriptions
The following table describes the fields on the Line Item Limit reimbursement tool.
|
Field |
Description |
|
Limit reimbursement to: % of charges |
Sets the maximum percent of the billed charge at which the line item can be reimbursed. For example, if you enter 75, no line item can be repriced at more that 75% of the billed charge. |