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Procedure Downgrades Estimates Unit Testing

These Unit Tests are for Procedure Downgrades estimates.

Test #60: Patient has a PPO plan which covers D2393 at 100%. UCR fee for D2393 is $300 and PPO is $120. D2393 downgrades to D2160 always. D2160 has a UCR fee of $100 and the PPO fee is blank. When adding a procedure for D2393 for this patient, the allowed amount should be $120, the writeoff should be $180, and the insurance estimate should be $120.

  • UCR fee for D2393: $300
  • PPO fee for D2393: $120
  • D2393 downgrades to D2160 always
  • UCR fee for D2160: $100
  • PPO fee for D2160: Blank
  • Add a D2393 for this patient
  • Allowed amount: $120
  • Writeoff: $180
  • Insurance estimate: $120

Test #61: Patient has a PPO plan which covers D2391 at 100%. UCR fee for D2393 is $140 and PPO fee is $80. D2391 downgrades to D2140 always. D2140 has a UCR fee of $120 and a PPO fee of $100. When adding a procedure for D2391 for this patient, the allowed amount should be $80, the writeoff should be $60, and the insurance estimate should be $80.

  • UCR fee for D2391: $140
  • PPO fee for D2391: $80
  • D2391 downgrades to D2140 always
  • UCR fee for D2140: $120
  • PPO fee for D2140: $100
  • Add a D2391 for this patient
  • Allowed amount: $80
  • Writeoff: $60
  • Insurance estimate: $80

See Also:
HL7 Unit Tests
Payment Plan Unit Tests
Repeating Charges Unit Tests

 

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