Skilled Nursing Facilities

Contents

Updating Payer Setup for Rate Enhanced Billing

After the rate enhancements are enabled in your database, you need to update the following areas of Payer setup.

  1. Do one of the following: 

    • Single Facility: Admin > Setup > Payers

    • Multi-facility: Management Console > Standards > Financial Management > Payers. 

  • Bill in Advance - Select to pre-bill the resident. Pre-billing is a best practice for most organizations. Select if you need to pre-bill this payer. 

    Note

    Bill in Advance in Payer setup replaces any option previously selected in rate schedules. 

  • Stop Billing Day - Indicate the date the application should use for discharge/deceased census entries specific to this payer. For example, if you bill the resident for the day of discharge, the stop billing date is the day after the discharge date. Select as needed. 

  • Care Level Template - Configure additional rates that are Payer specific. For example, assign multiple rates for a variety of room amenities. 

  • Payer Coverage - Set to Primary if there is only one payer necessary for the billing. If multiple payers cover the charges, set the coverage to Primary & Secondary. 

  • Generate Bills Options - Room Rate To Use - Select Reimbursement rate. This ensures the reimbursement rate shows on the statements if configured and used in rates. 

  • Allow Custom rates - Select to allow override of custom rates. 

    • Allow override standard rates - If selected you can further select to override standard or reimbursement rates and set custom rate limits for increases or decreases based on a percentage or dollar amount.

      • Set custom rate limits - Set thresholds for maximum increase or decrease of custom rate by percentage or amount. 

    • Allow override reimbursment rates - Select as for standard rates.

  • Allow Automaitc Write-Off in Cash Receipts. - Select to show the write off line in manual cash receipt distribution entries. 

    • Maximum Amt - Select to configure a maximum write off amount, if left blank there is no threshold on the write off amount in the cash receipt distribution. 

    • Charge Code - Select the write off charge code you configured for use in the write off entry.