Skilled Nursing Facilities

Creating New Payer Rules and Rate Schedules

Payer Rules and Rates Schedules must be configured for every facility for each payer and schedule. A new Payer Rules and Rate Schedule must be configured if rates or revenue codes change for the payer, or if there is a new contract for a payer.

Payer Rules and Rate Schedules are completed at the facility.

Multi-facilities can save significant time by configuring Payer Rules at the Management Console and copying the rules to the payers in each facility. If you create rules at the management console, you can schedule the rule update to apply overnight to each facility. If a rule update is created at the management console and scheduled to apply overnight, at the facility, the Payer Rule and Rate Schedule has a message it is scheduled.

Single facilities configure the Payer Rules at the facility in Payer Rules and Rate Schedules. 

Note

You cannot delete a payer rule and rate schedule if residents are using the rates.

  1. Do one of the following: 

    • Single facility: Admin > Setup > Payer Rules and Rate Schedules.

    • Multi-facility: Management Console > Standards > Financial Management > Payer Rules.

  2. Select the Payer Rank and the Payer.

    1. Type the Schedule Start Date.

    2. Leave Schedule End Date blank.

    3. To set up payer and ancillary rules on the new line, select Copy prior Payer Rules and Ancillaries. After you create the new Payer Rules and Rate Schedule or new rule line, you can edit and change the rules as required. If you want the rules to be blank, clear the option.

  4. Click edit payer rules, edit bill form rules, and/or edit ancillary rules and change options as required.

    For more information, see Creating Payer Rules and Creating Ancillary Rules.

  5. In a multi-facility, 

    1. To update the rules from Management Console for the payer in all facilities, click accept.

    2. To schedule the rule update to apply overnight to Residents census and rates across all facilities, click schedule apply.

  6. For information on completing rates, see Creating Rates and Creating Rate Templates.