Skilled Nursing Facilities

Creating Rates for Residents on Subsidy

You have 3 options in billing Residents on subsidy when using Rate Enhanced Billing. You need to discuss these options with the Accountants of your facility to determine what works best for reporting purposes and for ease of billing in your Facility. It is important you be consistent and commit to one of these approaches for all Residents on subsidy in your facility.

Rate options to consider

  1. Create a Custom Rate modify the Standard (STD) rate to a custom rate. In this approach you only account for the Resident portion of the billing. The Journal Entry at the end for the month only includes the Resident portion in the Custom Basic Revenue Account. There is no accounting for the Subsidy portion in this approach. This is considered the best practice for Subsidy.

    1. Facility > Admin.

    2. Resident > Census/Rates > Census.

    4. Room Rate = Basic Custom.

    6. Under Rate History, Click Rate STD.

    7. Customize the Monthly and Daily Charge Amounts as appropriate.

      Note

      You need to calculate the Daily Charge Amount and input. In certain Provinces this is always the Monthly amount divided by 30.416. For example $1,500 / 30.416 = $49.32.

    8. Click Generate Transactions button to update billing and review details on the Unbilled Transactions Report.

  2. Use Payer Rules to Contract off the Subsidy portion. The difference between the Resident and the Subsidy Accommodation revenue is written off to a separate GL account based on the configuration in the Payer Rule for the Resident Payer. This is configured in the Payer Rule to map the same Basic Custom GL account or is mapped to a separate Subsidy Revenue GL account. The Journal entry in this example nets out the same charge to the Resident Payer as in step 1, but does provide detailed accounting for the Revenue of both the Resident and Subsidy portion.

    Admin > Setup > Payer Rules & Rate Schedules > Payer - Resident > edit Payer Rules > Does payer have a coverage limit > Yes > Select Write-off to: use list to select GL account> Save.

    1. Resident >Census/Rates > Census > New/Edit

    2. Payer Options > Use Payer Setup file created by this Census Entry > Ok

    3. Coverage Limit - type the amount the resident covers. This is not the subsidy amount.

    5. Rate History > to expand the payer tree to confirm coverage limit configuration applied to resident.

    6. Click Generate Transactions button to update billing and review details.

  3. Use a Payer Tree to account for both the Subsidy Payer and Resident Payer. Similar to billing for Subsidy in PCC today using the original rates. This is the most complicated and time consuming option. Using this approach you continue to clear the Subsidy Payer receivable every month. This approach results in two invoices, one for the Resident and one for Subsidy. As the cash for the Subsidy Payer is not receipted through the application, there is no benefit in using the Subsidy Payer. You continue to force the Subsidy receivable to zero every month, by creating auto clear cash receipt batches.

    Admin > Setup > Payer Rules & Rate Schedules > Payer-Subsidy > edit Payer Rules > Select Pass to next Payer> Save

    Note

    Subsidy Payer must be configured for both Primary & Secondary under Payer Coverage when using this option.

    1. Resident> Census/Rates > Census > New/Edit.

    2. Payer > Subsidy.

    3. Payer Options > Create new Payer Setup file > Save > Ok.

    4. Coverage Limit - type the amount covered by Subsidy.

    5. Secondary Payer > use search icon to select Resident. Leave coverage limit at zero.

    7. Refresh the screen.

    8. Under Rate History, expand the Payer tree by selecting the plus sign, and confirm the setup.

    9. Select Generate Transactions button to update billing and review details on Unbilled Transaction report.