Business Units – Settings – Financial

Pay Rates Calculator Options

Use this section to activate Pay Rates Calculator and define basic settings for working with this functionality. For more information on this functionality, see Pay Rates Calculator Workflow in Help.

Once the license for PRC is provided for your agency, activate the Pay Rates Calculator by selecting the Use Pay Rates Calculator check box and entering the first day to use PRC.

When you turn on the PRC or PD licensing, make sure that you restart the accounting service in order for the data to be displayed correctly.

To work with Pay Rates Calculator, complete the following fields as applicable for your agency:

Field	Description
Suppress generation of Late Services	Select not to include services entered after the Pay Cycle is closed into the pay rates calculation.
Suppress generation of Adjustments	Select not to generate pay rate adjustments after the Pay Cycle is closed.
Suppress Overtime Calculation	Select not to include overtime calculation in the pay rates calculations.
Check Employee Overtime and Maximum Limits	Select one of the following options to set up warnings when the resource exceeds the overtime or maximum visit limits as defined in the Maximums and Warnings step in Pay Rates Calculator>Settings>Overtime Wizard: Always – Warnings are shown every time when a service is scheduled or verified. If the verified service is unverified and no changes are made to it, a warning is displayed again during the service reverification. Selecting this radio button may affect the application performance. Always except verification of previously scheduled services without changes – Warnings are shown every time when a new service is scheduled. They are not shown when the service is verified or reverified without changes.
Calculate Overtime across Business Units	Select to use all time entry for staff shared across Business Units. These changes apply to open cycles only.
Master Business Unit	Select to mark Business Unit as the Master for overtime calculations. It means that the shared Business Units will use the Master's overtime definition information in their pay rates calculations.
Optional	Specify the value in the Payroll Company Code field if your Payroll payment software requires an identifier for the Business Unit. This field may be required by your export target software.

Prepayments

Use this section to set up posting of payments made ahead of services provided. Prepayments are usually used by the Private Duty agencies when collecting payments for future services.

Select the Prepayments check box to allow prepayments to be posted for patients.

You must also select the appropriate adjustment options for prepayments:

Field	Description
Generate Takeback	Generates the takeback payment type for prepayment claims.
Generate Adjustments	Generates adjustments for prepayment claims with the adjustment code specified in the Adjustment Code field.

Small Balances Adjustment

Use this section to adjust claims automatically with a certain ageing date and outstanding balance in accordance with your agency's policy. The system will write off the balances overnight.

By selecting the History button, you can check the history of how the Small Balances has been set up and edited. For detailed steps on how to set up small balances adjustment, see Setting Up Small Balances Adjustment.

Miscellaneous Options

Specify the start date for all initial claim cycles in the application in the Claim Generation Start Date field. The claim start date is the starting point for billing in the application. Any services entered prior to the start date of claim generation are not included in any billing cycles. This restriction includes any voids and replacements for services prior to this date.

The system cannot perform any claim processing until you set this date. Once the date has been set, only the Netsmart Homecare representative can change it.

Once you set up claim generation start date, complete the following fields as applicable for your agency:

Field	Description
Report Billing Register by Branch	Select to split the Billing Register data by branch if your Business Unit uses the branches functionality.
Hide CSP Adjustment Types in Collections for Non-CSP Claims	Select to exclude the CSP adjustment types in the Collections/Patient window for non-CSP claims. This option is available only if you close the primary claims, CSP claims, and the CSP Deduction check box is selected in the Adjustment Types window.
Allow Patient Level Resource Negotiated Pay Rates	Select to enable selection of individual patients for whom the resource will be paid a specific amount in Resource>General>Negotiated Pay Rates. When this option is activated, you can select all service codes when specifying a negotiated pay rate.
Allow Immediate Cycle End Date Prior to Last AR Close Date	Select to allow defining the immediate cycle end date prior to the last AR close date for the claim.
Allow Cash and Expense Accounts Insurance Definitions	Select to allow definition of multiple General Ledger accounts belonging to Expense and Cash groups in the General Ledger Accounts window in Administration>Financial. This options also activates selection of the General Ledger expense and cash accounts in Administration>Financial>Insurance Codes and Administration>Financial>Insurance Companies. Note: To access the General Ledger Accounts window, you need to have the appropriate privilege assigned by the Netsmart Homecare administrator.
Apply Payments/Adjustments to voided claim if appropriate replacement is not found	Select to apply payments or adjustments through the ERA window to voided claim if the appropriate replacement is not found. If payments or adjustments are not applied, the corresponding data are displayed in the Remittance Advice report.
Limit EMC file to [number] claims	Select to generate multiple files during the EMC processing if the total number of claims exceeds the limit defined. If the EMC file contains more claims than you defined, it is split into several files (with the underscore and sequential number in suffix). If splitting the EMC file can cause the splitting of claims for the same patient, it is split so that all the claims for the same patient remain in one file, disregarding that the number of claims in a file does not correspond to the defined limit.
Allow editing Net billing basis	Select to make the Net Basis column in Administration>Financial>Billing Rates>Rates active and allow selecting net basis and its additional parameters different from the gross basis.

Managing HIPPS code for claim generation

During final PPS claims processing, the application ensures that the therapy visit requirement associated with M2200 (OASIS C and OASIS C1 assessments) has been met.

If less therapy visits than declared in the OASIS were completed for the patient and the Automatic Down- coding of HIPPS check box is selected, the application will down code the episode's reimbursement to match the CMS payment. If more therapy visits than declared in the OASIS were completed for the patient and the Automatic Up-coding of HIPPS check box was selected, the application will up code the episode's reimbursement to match the CMS payment.

The recalculation is reflected on the final claim, but does not change the assessment data or HIPPS codes following the CMS guidelines.

Generating PPS Claims that Overlap Claim Generation Start Date

Netsmart Homecare provides the ability to create RAP and final claims for all PPS episodes that start before the claim generation start date, but end on or after the claim generation start date. You can change this setting until your agency closes a claim cycle that includes one or more PPS pay sources.

For example, if an episode's 60-day period includes the claim generation start date, that episode is processed. However, if the Generate claims for PPS episodes that overlap the Claim Generation Start Date option is not selected, such episodes are not processed and claims are only generated for the PPS episodes that begin on or after the start date of claim generation.