Negotiated Rates for Patients

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Negotiated Rates Window

Path: Patient>General>Negotiated Rates

With the Negotiated Rates window, you can customize insurance coverage dollar amounts or percentages for a patient if those amounts differ from those previously defined in Administration>Financial>Billing Rates or Administration>Financial>Insurance Plan Rates for that insurance carrier and plan.

Rates you enter here override rates in either of those data entered in the Administration component.

When negotiated rates exist, they indicate that a special arrangement has been made for the individual patient. Therefore, on claims for a patient with negotiated rates, Netsmart Homecare prints the gross or net amount (as selected) regardless of the normal print variations for the pay source.

You can enter custom rates for commercial insurance and self-pay only. To set up an insurance code to allow for custom rates, go to the General tab of Administration>Financial>Insurance Codes and select Allow Negotiated Rates.

Entering Special Insurance Rates for Patients

Before entering negotiated rates, you must first have added the patient's payers.

1.	Go to Patient>General>Negotiated Rates.

2.	Select the payer for which you want to enter a negotiated rate.

3.	Add a new row.

4.	In the Print on Claim section, select the Gross Rate radio button to print the gross rate on claims, or Net Rate to print net rate on claims. The system always generates accounts receivable at net rate.

5.	To specify individual rates per service, click Specify Individual Rates. To specify a percentage of each visit amount, click Specify Single Percent.

6.	Enter the date when this negotiated rate becomes effective.

7.	Enter the rate code to which this negotiated rate applies.

Rate codes available here are defined for the insurance code in Administration>Financial>Billing Rates.

8.	If you selected to specify a single percentage, enter the percentage of the original rate that this negotiated rate represents.

9.	If you selected to specify individual rates, enter the negotiated rate and basis for the rate code.

For each basis code and description, see Billing Rate Basis Codes.

10.

Save your changes.

Important: If you are changing already defined negotiated rates, the system notifies you that you have changed information that affects current accrual accounting data. After saving your edits, you need to run the Recalculate Accrual Accounting utility in Administration>Maintenance if the selected patient has billable services with negotiated rates to reflect recent changes on the accrual accounting reports.