Creating accurate estimates in Rivet Health ensures transparency and trust between your practice and patients. Whether dealing with multiple insurance plans or coordinating procedures across various locations and providers, Rivet makes the process straightforward. This guide outlines the different scenarios that necessitate an estimate and provides detailed steps for each type.
Create a basic estimate if the following conditions apply:
The patient has one primary insurance or opts for self-pay.
The procedure(s) are performed in one location.
The patient is seen by one provider.
The patient is coming in for a one-time visit.
Creating an estimate involves various pieces that all come together to create an accurate estimate that has been simplified with Rivet to create a basic estimate. The steps for creating a basic estimate also form the foundation for more specialized estimates.
To create a basic estimate you are going to need to know a few things:
Patient information
Insurance information
Provider
Service location
Date of service
Procedure codes
Fee schedule
Depending on how you are set up with Rivet most of this information will be pulled in from the system on your end. Finding a patient and their appointment typically is the easiest way to pull this information into an estimate.
To start an estimate from an appointment.
Click Estimates > Appointments at the top of Rivet
Use the filters on the left or the search bar to find the patient.
Click the 3 dots on the right side of the appointment > new estimate.
Since you are creating an estimate from an appointment it will automatically fill in the provider, service location, and the service date.
The next step is to fill in the codes into the code box. Note: there is also a spot for diagnosis codes but these are optional and not required to complete an estimate.
Depending on how your account is set up you may need to select a fee schedule or it may be configured to select by default depending on the patient's insurance.
Review the patient’s benefits. We run an eligibility check to pull in up-to-date benefit information from the Payer but it's a good practice to review and make sure these look correct.
Optionally you can add a note to configure payment request details for a given estimate.
Finally, complete the estimate.
Choose how you want to send the estimate to a patient you can choose to send it via SMS email or download a PDF copy. The email and cell phone number will need to be added to a patient to be able to share this way.
2. Multi-Treatment Estimate
Creating an estimate for a patient involving multiple providers, locations, or dates of service can be complex. But with Rivet using our multi-treatment process should make it fairly simple to correctly estimate multiple treatments for a patient.
Adding Initial Treatment Information
Adding Additional Treatments
Eligibility Checks and Deductible Calculations
Managing Treatment Boxes
Removing Treatments
1. Adding Initial Treatment Information
To begin creating a multi-treatment estimate, start by following the steps for a basic estimate. Ensure all information is accurate to set a solid foundation for the estimate.
2. Adding Additional Treatments
To add another treatment:
Click the 'Add treatment' button located underneath the initial treatment box and choose a treatment type.
A new treatment box labeled 'Treatment 2' will appear.
Enter details that differ from the initial treatment, such as a different provider, location, or date of service and additional codes.
Repeat this process for any additional treatments required for the patient.
3. Eligibility Checks and Deductible Calculations
For each additional treatment:
A separate eligibility check is performed to account for differences in providers or procedures.
The deductible and out-of-pocket fields are recalculated based on patient responsibility information from the first treatment.
Each treatment box requires its specific codes and details to ensure accurate pricing.
4. Managing Treatment Boxes
Treatment boxes can be collapsed for easier readability:
Click the arrow at the top right of the treatment box to minimize or maximize it.
This feature helps maintain a clean and organized workspace, especially when dealing with multiple treatments.
5. Removing Treatments
To remove a treatment before finalizing the estimate:
Click the 'Remove treatment' button located at the bottom left of the relevant treatment box.
This can be done at any time before completing the estimate, allowing flexibility in adjusting the treatment plan as needed.
3. Multi-Payer Estimate
Creating an estimate for a patient with multiple insurances can be straightforward with Rivet. Whether the patient has primary and secondary insurance or even tertiary insurance, the process remains similar to basic estimate creation with an added step for benefits checks. This guide will walk you through the necessary steps to ensure accurate and efficient estimate creation for patients with multiple insurances.
Starting the Estimate Process
Enabling Secondary/Tertiary Insurance Benefits Check
Adjusting Insurance Toggles
Completing the Estimate
Viewing Benefits and Pricing Summary
1. Starting the Estimate Process
Begin the estimates creation process as you normally would, following the steps outlined in the basic estimates.
Create a multi-payer estimate if any of the following conditions apply:
The patient has primary and secondary insurance.
The patient has primary, secondary, and tertiary insurance.
2. Enabling Secondary/Tertiary Insurance Benefits Check
Once you start the process, you will see toggles next to the patient's insurance names. These toggles control the benefits check for each insurance. By default, Rivet runs benefits for the primary insurance only. To include secondary or tertiary insurance, slide the respective toggles to 'on' (purple).
3. Adjusting Insurance Toggles
At any time before completing the estimate, you can adjust these toggles. If a toggle shows as white, it is 'off'. Slide the toggle to 'on' to run benefits checks for the additional insurance. Rivet will then concurrently run benefits checks for the selected insurances.
4. Completing the Estimate
Continue with the estimate creation process as usual. Ensure that the appropriate fee schedule is either auto-populated or manually selected based on the patient’s plan type. Enter all relevant codes necessary for the estimate.
Note: If the patient has multiple providers, locations, or dates of service, refer to the walkthrough for creating a multi-treatment estimate.
5. Viewing Benefits and Pricing Summary
The primary and secondary benefits will appear in the floating modal displaying the pricing summary. For a detailed view of the pricing logic for specific procedures, click on any highlighted codes.
4. Advanced Edits
When creating an estimate, you may encounter insurance or benefit information that doesn't match your expectations. There are two main ways to address this: manually editing the fields or selecting a predefined benefit. After making changes using either method, the estimate will display "(edited)" in the adjusted fields. This guide will walk you through both methods to ensure accurate estimate creation.
Make advanced edits to an estimate if needed:
Manual Entry Edit
Selecting a Predefined Benefit
Post-Edit Display
1. Manual Entry Edit
To manually edit a benefit field:
Click directly into the benefits field you want to change.
Type the new value directly into the field.
Note that this manual change is specific to the current estimate and will not affect other estimates for the same patient.
To manually adjust a rate or description for a code:
Click advanced right about the code field
Enter in a new description in the description field or a new rate into the allowed field.
2. Selecting a Predefined Benefit
To select a predefined benefit:
Click the three-line icon located to the right of the numeral fields.
A modal will appear, showing different benefit options based on the service type.
Select the desired benefit option by clicking on the appropriate circle to the left of the benefit and click submit.
The selected option will be copied into the relevant estimate benefits field.
3. Post-Edit Display
After making changes using either method, the estimate will display "(custom)" in the fields where adjustments were made. This indicates that the information has been manually or selectively modified.
By understanding these scenarios and utilizing Rivet's estimation capabilities, you can provide your patients with clear and accurate cost information.
For further assistance, please contact our support team via chat or email at support@rivethealth.com.
Suggested Next Article: Accessing Patient’s in Rivet