Your rates. Rates lists your agency's contracted rates for each payer: Medicaid waiver, Medicaid managed care, Medicare, the VA and long-term care insurance. Each rate names a service, an optional HCPCS code and modifier (for example T1019 with the modifier your state uses), the unit and the rate per unit. These are your agency's rates to its payers; ExpressAgain never sets them. Edit changes one; Remove switches it off, and invoices already made keep their prices.
Private pay. A private pay client keeps each home's own rate: the rate on each professional's terms in that home, exactly as Billing & pay prices the invoice. There is no private pay row on Rates.
Units. Hour bills the hours worked (unpaid breaks out). 15-minute unit counts each visit by the usual 8-minute rule: every full 15 minutes is one unit, and 8 minutes or more left over is one more unit, so 7 minutes is no unit, 8 minutes is one, 22 minutes is one and 23 minutes is two. Visit counts one per visit, and Live-in day one per live-in shift. Each visit is counted on its own, then priced.
Each client's payer. Under Authorizations, Each client's payer shows every client home with the payer the family set in its own billing settings. Pick the payer the client is billed under (for example VA, which the family's settings do not list) and, when you have more than one rate for that payer, the rate. With one rate for a payer, that rate is used; with several and none picked, the one whose service matches the visits.
Authorizations. Add the authorization each payer issued: the client, the payer, the number, the service code, the unit, the units authorized and the first and last day. Units used are counted from the closed visits in those dates, in that unit. The pill reads Authorization with the units used and authorized, turns amber at 80 percent, reads Over authorization past the units, and Authorization expired after the last day. Ready to bill shows the same pill on that client's row, and a new invoice for a payer client carries the authorization number, dates and units.
Step by step
- 1Open Billing, then Rates, and tap Add a rate for each payer and service you bill.
- 2Open Authorizations, open Each client's payer and set the payer for any client whose payer is not right.
- 3Tap Add an authorization for each Medicaid, managed care or VA client and type what the payer issued.
- 4Watch the pills: amber means 80 percent of the units are used; ask the payer for more before the client runs over.