Billing Contract Amounts
The Resident Fees/Payers screen is the heart of the billing process. It is where you enter supplemental packages, rent, and care packages when applicable. It is where you enter the resident Payers and contract amounts. We will outline how we recommend setting up the Fees / Payers section especially for waivered individuals.
The Fees/Payers screen will look SLIGHTLY different based on the resident's selected Billing Option. When a resident is on the billing option Care Package, there will be a field to select the care package.
When a resident is on the Billing Option Fee For Service, there will be no "care package" section on the Fees/Payers screen.
Setting Up Waiver Residents:
The following items will be set up EXACTLY as if the resident was paying privately. You typically do NOT enter "discounted" rates.
- Enter all services and when applicable specify included or not included in package
- Enter the correct Care Package / Level as if the person was paying privately
- Enter the Rent if applicable
- Enter any Supplemental packages that would apply - mark "included in contract" if it needs adjusted off
Setting Up Waiver Resident's Payers:
Before implementing billing for facilities who have residents with county or waiver payers, our support team will turn on a configuration option "Restrict the program names in payer screen". This will allow you to select what the "payer" is covering. It will either be rent or services. After the "bottom section" of the fees/payers screen is entered (Supplemental Packages, Rent, Care Packages) we will start entering the Payer Information.
- Open the Resident Fees/Payers screen
- The Payers section is at the top of the screen
- Select the Payer in the first column
- Select the Program - You will have the options: Rent - GRH, Rent - Private, Services - EW, Services - EW Other, Services - Private, Spend Down Private (services)
- Enter the contract amount
- Select the "Per" option (month or day)
How it Works:
The "Payer" section will be compared to the "bottom" section. Anything in the payer section with a program name that specifies "Rent" will be calculated against
Anything in the payer section with a program that specifies "Services" will be calculated against:
- Service revenue supplemental packages
- Care Packages
- Fee for service or items NOT marked "include in package"
NOTE: The contract amount MAY be different than what you calculate on the Fees / Payers screen. This could be due to:
- Incremental services not marked as included in the care package
- Unscheduled services entered during that billing period
After you create invoice lines you may see one or two "adjustment" lines in the resident charges screen. This would be visible with the campus configuration: Show contractual adjustments in billing screen is set to yes.
PLEASE NOTE: The contract adjustments do NOT show on any statement or invoice. They are to show the gain or loss from a facility accepting a contract rate. They will show on the billing screen and reports after posting such as the "Contractual Adjustments".
The charge screen will show the adjustment lines and one line for each "payer" with the contracted rate: