The Sliding Fee Schedule simplifies the process of determining patient responsibility by automatically calculating discounts based on the patient's income and household size. After a patient's eligibility information is entered and verified, the system determines the applicable sliding fee amount or percentage according to the configured sliding fee schedule.

When a qualifying encounter is created, the system automatically applies the appropriate adjustment, ensuring the patient is responsible only for their calculated sliding fee amount. This helps practices consistently apply financial assistance policies, reduces manual calculations, minimizes billing errors, and ensures eligible patients receive healthcare services at a more affordable cost.

Create a sliding fee schedule

Click Utilities. 

Click Preferences, then Company Preferences. Scroll down to the Payment Settings section and enable the Enable Sliding Fee toggle. 

Click Save to apply the changes. To ensure the new setting is applied correctly, log out of RXNT and then log back in.  

After logging back in, click Utilities.

Click Practice Setup and then Sliding Fee.

To manage the master sliding fee, enter the patient salary ranges in the Beginning Salary and End Salary columns. Then, select the patient responsibility for each corresponding dependent column. Be sure to click Save to apply the settings.

Note: System validation has been updated to allow the same patient responsibility amount or percentage to be configured across multiple salary ranges. Previously, the system prevented duplicate dependent responsibility values when salary ranges overlapped.  

With the updated functionality, each salary range is validated independently, allowing the same dependent amount or percentage to be used across different salary ranges.

Example:

• Salary Range 1: $0–$900
  • 0 Dependents: $100 patient responsibility
  • 1 Dependent: $75 patient responsibility
• Salary Range 2: $0–$1,000
  • 0 Dependents: $100 patient responsibility
  • 1 Dependent: $75 patient responsibility

This configuration is now valid because the dependent responsibility amounts are evaluated separately for each salary range. Salary ranges themselves cannot overlap within the same configuration.

Set up a patient's sliding fee

Navigate to the Patient Dashboard Demographics screen (click on the patient’s name in the dashboard) for applicable patients.

This opens the Patient Profile screen. From here, click the Sliding Fee button to open the Patient Sliding Fee screen.

Select Enable sliding fee for this patient, then enter the required information:

• Patient's Salary: The patient's total annual income.
• Spouse's Salary: The patient's spouse's total annual income.
• Other Income: Any additional income the patient receives outside of their salary.

The Patient's Salary, Spouse's Salary, and Other Income amounts are combined and used to determine the appropriate sliding fee table row.

• Number of Dependents: The number of individuals the patient is financially responsible for, such as children or a non-working spouse. This value determines the applicable sliding fee table column.
• Verified Date: The date your practice received the required documentation confirming the patient's eligibility for the sliding fee.
• Calculated Sliding Fee: The amount the patient is responsible for paying, either as a percentage or a fixed dollar amount.
• Documents Received: The supporting documentation collected from the patient to verify eligibility information.

These details ensure the patient's applicable sliding fee is calculated accurately.

After entering the required information, click Save to apply the sliding fee settings to the patient. 

Automatic patient balance write-off 

The Calculated Sliding Fee amount or percentage displayed on the Patient Sliding Fee screen determines the patient's responsibility. This is the amount the patient is required to pay, regardless of the total charges for the encounter. 

Self pay case

If the patient encounter is linked to a Self Pay case, the system automatically creates a patient payment adjustment after charges are created. This payment adjusts the balance so that the patient is only responsible for the Calculated Sliding Fee amount.

Example: The patient's calculated sliding fee amount is $75, and an encounter is created with $150 in charges. The system automatically applies an adjustment to reduce the patient balance, leaving the patient responsible for only the $75 sliding fee amount.

A patient payment is created with an adjusted amount of $75, leaving a patient responsibility of $75 from the original $150 total charge amount.

The payment adjustment details are displayed under Payment Details and are also shown in the Encounter Summary within the Patient Activity section. 

To view the payment adjustment details, click the Payment Number. The ADJ: SLIDE adjustment code is displayed in the Adjustment Code field, indicating that the amount was adjusted based on the linked sliding fee schedule. 

A note is created within the Payment and Encounter screens indicating that a zero-dollar patient sliding fee adjustment was created for the encounter. 

Health insurance case

If the patient encounter is linked to a Health Insurance case, the system automatically creates a patient payment adjustment after the insurance payer payment has been posted. This adjustment reduces the patient balance so that the patient is responsible only for the Calculated Sliding Fee amount.

Example: The patient's calculated sliding fee amount is $75, and an encounter is created with $175 in charges. The payer payment of $75 is posted, and the system automatically applies the necessary adjustment to reduce the remaining balance, leaving the patient responsible for only the $75 sliding fee amount. 

After an insurance payment has been posted, the system automatically creates a patient payment adjustment to apply the sliding fee schedule and update the patient's remaining responsibility. 

To view the insurance payment details, click the Payment Number.

The payment details show that the payer allowed $175 and paid $75, leaving a $100 patient balance before the sliding fee adjustment is applied. 

To view the payment adjustment details, click the Payment Number. The ADJ: SLIDE adjustment code is displayed in the Adjustment Code field, indicating that the amount was adjusted based on the linked sliding fee schedule. 

A note is created within the Payment screen indicating that a zero-dollar patient sliding fee adjustment was created for the encounter. 

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