Skilled Nursing Facilities

Creating Payer Rules

You can create Payer Rules at the Management Console. Payer rules are setup for each payer. You can define if the payer has a coverage limit, the amount, and what the rules are after the coverage limit is reached. Creating Payer Rules at Management Console saves you time when configuring Payer Rules and Rate Schedules. 

Configuring the Payer rules at the Management Console is only available for multi-facility organizations. Payer rules can be configured at the facility level using Payer Rules and Rate Schedules setup. 

Note

Before configuring Payer Rules, Payers must be setup in the database. 

Note

Before creating Payer Rules you, must create Payers.

  1. Do one of the following:

    • Single Facility: Billing > Setup > Payer Rules and Rate Schedules.

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

  2. Complete the following fields:

    • Facility.

    • Payer Rank.

    • Payer.

  3. Click edit payer rules.

  4. Do one of the following:

    • Does payer have a Coverage Limit. Select No and no further work is required. 

    • Does payer have a Coverage Limit. Select Yes and new fields appear. Complete as appropriate.

  • Contribution Payer - Appears only if Contribution Payer is selected in Payer Setup. 

    Note

    Only one payer rule appears for Contribution Payer.

    • Default Amt - Type the amount if it is the same for all residents. If the amount differs for residents, type 0.00. You can type each resident's amount in Census and Rates Payer Setup.

    • Frequency - Select for how often the amount is transferred. 

    • GL Account (+) - Select the account to debit the contribution Payer.

    • GL Account (-) - Select the account to credit the primary payer.

  • Does Payer Cover Deductibles? - Select for secondary payers covering deductible or liability. For example, resident liability or share of cost payers. 

  • If using coverage limit, you can select to split an invoice with another payer by selecting Pass to next Payer. 

  • If you want to charge a full rate and then reduce the charge for a subsidy portion you can use the write off to field to designate the account to map it too.