Patient Member Responsibility (PMR): Smarter Copay, Coinsurance & Deductible Tracking

This guide walks through how Patient Member Responsibility (PMR) helps your practice estimate and collect what patients owe — accurately and at the time of service.

Because sending statements and hoping for the best is not a growth strategy.

Why PMR Matters

Estimating Patient Member Responsibility (PMR) is one of the most powerful financial tools in your practice. When you know what a patient owes at checkout, you can:

• Collect at time of service instead of chasing balances later
• Improve cash flow
• Reduce billing confusion
• Increase patient transparency

ChiroSpring includes advanced PMR logic designed to make these calculations accurate and efficient.

Watch training video here

Patient Member Responsibility Settings provide:

Detailed Patient Financial Breakdown

• Insurance responsibility
• Patient responsibility
• Copay
• Coinsurance
• Deductible
• Allowed amounts vs. charged amounts

Streamlined Front Desk Workflow

• What to collect at checkout
• Automated modifier additions

Advanced Reporting & Insights

• Enhanced Aging Report
• Claims history tracking
• Expected vs. paid comparisons

Next you will want to determine if your practice (at the practice level) wants to calculate PMR using copay, coinsurance and deductible. Some practices, as an example, may not want to collect coinsurance. In that example, you would want to uncheck (exclude) coinsurance. To access these settings go to settings/clinic/customization. Then select PMR preferences.

1. Click Settings
2. Clinic
3. Customization:

3. Click into the PMR/Billing Tab
4. Set your PMR preferences

We already defined our PMR calculations are incredibly accurate as we segment chiropractic, therapy and general (into three groups). For practices that do not want multiple groups you may remove groups by toggling them off. See below.

Here you can remove chiropractic specific benefits and therapy specific benefits.

For patients that may want PMR NOT to estimate based on copay or coinsurance or even deductible, you can exclude those options as well at the PER PATIENT level. To do this go to the patient. At the bottom select 'Patient Preferences'.

While your practice may have default PMR settings, you can override them for individual patients.

To adjust PMR at the patient level:

1. Open the Patient Profile

   Scroll to Patient Preferences

   Enable or disable:

   • Copay
   • Coinsurance
   • Deductible

These selections override practice-level defaults for that specific patient.

This is especially helpful when:

• A patient requests simplified estimates
• You choose not to collect certain components for a specific case
• Special arrangements are in place

Before PMR can calculate accurately, you must enter procedure allowances.

What are allowed amounts?

These are the amounts an insurance carrier allows for a given charge.

How to Set Up Procedure Allowances

1. Go to: Billing > Settings > Third Party Payers
2. Select a payer
3. Click Configure (top right)

For each service line item:

• Check Covered if the payer covers it
  • If not covered, leave unchecked. PMR will estimate the full amount as patient responsibility.
• Enter the allowed amount (up to 6 units per service)

You do not need to populate all six units, but the more complete your data, the more accurate your PMR calculations will be.

If no allowed amount is entered, the software defaults to the full charge when calculating PMR.

Be sure to click Apply and Save Payer when finished.

*Make sure to "Apply and save payer"

Within the same Procedure Allowances dialog, you can assign modifiers to services.

When that service is added at the Fee Slip, the modifier automatically applies.

This:

• Saves time
• Reduces human error
• Prevents missed modifiers

*Make sure to "Apply and save payer"

ChiroSpring estimates PMR using the information entered in the Insurance Verification section of the patient’s insurance profile.

If you are using the ChiroSpring Clearinghouse, you also have access to Instant Eligibility Verification.

Follow the full Insurance Verification setup article for step-by-step instructions on how PMR calculations use these entries.

Insurance Verification & Checkout: Managing Patient Member Responsibility (PMR) Complete Guide

And then you will be able to use PMR for checkout and further reporting!

Now for the part that impacts your revenue.

To access checkout:

• Click the Checkout icon for patient from the Front Desk Screen
• The Checkout Screen opens in it's own Dialogue

The screen displays:

• Outstanding Dates of Services with a Patient Owes amount Due
• Products with an outstanding balance

Select the visit(s) you want the patient to pay for using the checkboxes.

The system will:

• Automatically calculate the payment
• Display the payment amount in green (non-editable)

If you need to adjust the total, modify the Payment Amt. field on the specific claim or product.

At the bottom of the Cash Register, you’ll see a detailed PMR breakdown for the selected claims, including:

• Insurance responsibility
• Patient responsibility
• Copay
• Coinsurance
• Deductible

This allows you to confidently collect the correct amount before the patient walks out the door.

What You Can Do From the Checkout Screen - Complete Guide

You can:

• Create an appointment
• View or edit the next appointment
• Request a 5-star review
• Print a payment receipt
• Apply unapplied money to services or products

It functions as a complete front desk control center.

The patient's Date of Service Ledger Line item on both the Claim history and Aging Report clearly defines a breakdown of PMR showing insurance owes, patient owes as well as a breakdown of copay, coinsurance and deductible.

Fee schedules are not part of PMR, but do allow you to provide a discount on any service for non-insurance claims. To create a fee schedule go to billing/settings/service list & fees.

Here is a full article on  Fee Schedules - CLICK HERE.

Click the + icon next to "Fee Schedules to create a new fee schedule. Once created you may edit the prices for any service.

You can set a default fee schedule for your patient on their Treatment Dashboard. This auto-populates this fee schedule for any non-insurance services added at Fee Slip. You can also change the fee schedule for non-insurance services at the fee slip at anytime.

You don’t need another polite, fluffy intro about “optimizing workflows.” You need a strong opening that makes it clear why this matters and a closing that ties the whole thing together without sounding like a brochure.

Here are two new summary sections you can use.

In Summary:

When PMR is fully set up — from procedure allowances and insurance verification to checkout and reporting — your practice gains financial visibility and control.

You can:

• Estimate patient responsibility accurately
• Collect confidently at time of service
• Reduce billing surprises
• Monitor insurance vs. patient balances through reports and ledger views

Combined with proper fee schedule management and reporting tools, PMR becomes more than a feature. It becomes a structured financial system that supports consistent cash flow and fewer collection headaches.

Set it up correctly once, use it daily, and let the system do the calculating so your team can focus on patient care instead of chasing balances.