Skilled Nursing Facilities

Creating Ancillary Rules

In Ancillary Rules, you define ancillary billing and contractual requirements specific to each Payer:

  • Revenue Account

  • Reimbursement reduction

  • Coverage Limits

  • Co-insurance

You must create Ancillary Rules in each facility. To save time configuring in multi-facility databases, create Ancillary Rules at the Management Console. If you create ancillary rules at the management console, you can schedule the update to apply overnight to each facility. In a single facility,the rules automatically update the payer rules and rate schedules. 

Note

Before configuring Ancillary Rules, you must configure Ancillary Charge Codes.

  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:

    • Facility

    • Payer Rank

    • Payer

  3. To create a rule for a new effective date, click New. 

  4. Click edit ancillary rules. The first time you access Ancillary Rules for a Payer, the screen is blank.

  5. Create templates for each type of ancillary the Payer covers by clicking New. 

  6. Click manage charge codes.

To quickly setup ancillary rules, copy ancillary rules from a Payer with the same or similar rules. Then, edit ancillary rules and change settings as required.

  1. Click copy ancillary rules.

  3. Scroll and select all the applicable ancillary templates to copy.

  5. Click edit ancillary rules.

  6. Change options as required.

  • Edit rules - Select option.

    • Does Payer cover these Charge Codes? - Select option if the Payer covers the ancillary. 

      • Revenue Account - Select option.

      • Reimbursement - Select one of the following:

        • Type the reimbursement percent and select the source of the charge amount. 

          • Contra Account - Appears if you enter less than 100 % Reimbursement. Select the GL account to book the contractual allowance .

        • Daily Amount - Select to define a daily maximum amount the payer reimburses.  

          • Type the amount the payer reimburses per day.

          Note

          If the payer has different daily reimbursement limits for charges associated to the same ancillary template,

          1. Create a new ancillary template and complete the rules including the reimbursement daily limit.

          2. Clear the relevant charges from the existing ancillary template and associate the charge(s) to the new template.

  • Manage charge codes - All charge codes available in your facility appear, organized by Charge Code Category. Scroll to the Charge Code Category corresponding to the ancillary template. In the category, select all the ancillary charge codes covered by the payer. For example, if the ancillary template is occupational therapy, select only occupational therapy charge codes.

    • Charge Codes in ancillary rules can be managed at the management console. Under a charge code category in manage charge codes, you can select an individual charge code, multiple charge codes, or select a whole category. When you select a whole category, all the current charge codes are included. If a charge code(s) is added to the charge code category in the future, they are automatically selected.

  • If a Payer changes contractual requirements, or amounts for coinsurance, coverage limits, or other payment reductions, create a new rule line with the change effective date.