Pro-Rated Feed
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Admission
- Client Ledger
- Dictionary Update (PM)
- Post Residential/Inpatient Worklist
- Program Maintenance
- Registry Settings (PM)
- Service Codes
- Service Fee/Cross Reference Maintenance
- Diagnosis
- Discharge
- Financial Eligibility
- Guarantors/Payors
- Leaves
Scenario 1: Validate Pro-Rated Fees Calculation - Client without leave or discharge
Specific Setup:
- Registry Settings:
- The following registry setting has a value of '2', at a minimum: Avatar PM->System Maintenance->Service Code Maintenance->->->Additional Service Fee Configuration Fields.
- The following registry setting has a value of '5': Avatar PM->Services->Inpatient/Residential->->->Number Of Daily Charge Codes.
- Guarantors/Payors 1 is an active guarantor.
- Service Codes:
- Service Code 1: Is an active service code that will be used for pro-rated services room and board charges.
- Service Code 2: Is an active service code that will be used for pro-rated services daily charge (1).
- Service Code 3: Is an active service code that will be used for pro-rated services daily charge (2).
- Service Code 4: Is an active service code that will be used for pro-rated services daily charge (3).
- Service Code 5: Is an active service code that will be used for pro-rated services daily charge (4).
- Service Code 6: Is an active service code that will be used for pro-rated services daily charge (5).
- Service Fee/Cross Reference Maintenance:
- Service Code 1 - Service Code 6:
- From Date = desired date.
- Fee = desired amount, which is distributed across the monthly services. Note each value.
- UB-94 Revenue Code = desired value.
- Fee type = Monthly.
- Pro-Rate Fee For = desired values.
- Pro-Rated Fee Calculation = Fee/Monthly Days.
- Client:
- Is admitted to an inpatient program on or after the earliest 'Service Fee/Cross Reference Maintenance', 'From Date'. Note the ‘Unit’ the client is assigned to. Client has not been placed on leave or discharged during the month.
- Has a 'Financial Eligibility' record for Guarantors/Payors 1.
- Equations are used for fee verification based on the value in 'Pro-Rated Fee Calculation'.
- The value of 'Pro-Rated Fee Calculation' is 'Fee/Monthly Days'. The equation is: the 'Fee' divided by the number of days in the month, times the number of valid days, divided by the number of days in the month.
- Example 1: Fee is 350.00. Days in month = 31. Valid days = 31. 350/31 = 11.29 for days 1-30, and 11.30 for day 31.
- Example 2: Fee is 120.00. Days in month = 30. Valid days = 15. 120.00/30x15/30 = 2.00 for the valid days.
Steps
- Open ‘Compile Residential/Inpatient Charges’.
- Select ‘Individual’ in ‘Individual Or All Units’.
- Select desired Unit in ‘Select Unit(s)’.
- Set the ‘Compile Charges From Date’ to desired value.
- Set the ‘Compile Charges Through Date’ to desired value.
- Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
- Click [Process].
- Validate that the report fees are correct for each service code, ensuring that at a minimum the first and last page of the report are verified. Calculate the fees to verify that the fee in ‘Service Fee/Cross Reference Maintenance’ is correct for the valid number of days in the month.
- Open ‘Post Residential/Inpatient Worklist’.
- Select ‘Individual’ in ‘Individual Or All Units’.
- Select desired Unit in ‘Select Unit(s)’.
- Set the ‘Post Charges From Date’ to desired value.
- Set the ‘Post Charges Through Date’ to desired value.
- Click [Process].
- Validate that the report fees are the same as above.
- If desired, open ‘Client Ledger’ for the client and verify the fees for the date range and services.
Scenario 2: Validate Pro-Rated Fees Calculation - Client with leave only & Client with leave & discharge
Specific Setup:
- Registry Settings:
- The following registry setting has a value of '2', at a minimum: Avatar PM->System Maintenance->Service Code Maintenance->->->Additional Service Fee Configuration Fields.
- The following registry setting has a value of '5': Avatar PM->Services->Inpatient/Residential->->->Number Of Daily Charge Codes.
- Guarantors/Payors 1 is an active guarantor.
- Service Codes:
- Service Code 1: Is an active service code that will be used for pro-rated services room and board charges.
- Service Code 2: Is an active service code that will be used for pro-rated services daily charge (1).
- Service Code 3: Is an active service code that will be used for pro-rated services daily charge (2).
- Service Code 4: Is an active service code that will be used for pro-rated services daily charge (3).
- Service Code 5: Is an active service code that will be used for pro-rated services daily charge (4).
- Service Code 6: Is an active service code that will be used for pro-rated services daily charge (5).
- Service Fee/Cross Reference Maintenance:
- Service Code 1 - Service Code 6:
- From Date = desired date.
- Fee = desired amount, which is distributed across the monthly services. Note each value.
- UB-94 Revenue Code = desired value.
- Fee type = Monthly.
- Pro-Rate Fee For = desired values. If 'Missing Service Code' is not selected in the field, leave days will be counted as valid days.
- Pro-Rated Fee Calculation = Fee/Monthly Days.
- Dictionary Update:
- Client - Type of Leave From (757):
- Extended Dictionaries:
- Chargeable Leave Y/N = Y.
- Room And Board Billing Code Override = a Room & Board Code that is not Service Code 1.
- Client:
- Is admitted to an inpatient program on or after the earliest 'Service Fee/Cross Reference Maintenance', 'From Date'. Note the ‘Unit’ the client is assigned to. The service codes noted above are used in the 'Inpatient/Partial/Day Treatment' section of the form.
- Client has a billable leave during the month. Note the number of leave days. The client has not been discharged during the month.
- Has a 'Financial Eligibility' record for Guarantors/Payors 1.
- Equations are used for fee verification based on the value in 'Pro-Rated Fee Calculation'.
- The value of 'Pro-Rated Fee Calculation' is 'Fee/Monthly Days'. The equation is: the 'Fee' divided by the number of days in the month, times the number of valid days, divided by the number of days in the month.
- Example 1: Fee is 350.00. Days in month = 31. Valid days = 31. 350/31 = 11.29 for days 1-30, and 11.30 for day 31.
- Example 2: Fee is 120.00. Days in month = 30. Valid days = 15. 120.00/30x15/30 = 2.00 for the valid days.
Steps
- Open ‘Compile Residential/Inpatient Charges’.
- Select ‘Individual’ in ‘Individual Or All Units’.
- Select desired Unit in ‘Select Unit(s)’.
- Set the ‘Compile Charges From Date’ to desired value.
- Set the ‘Compile Charges Through Date’ to desired value.
- Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
- Click [Process].
- Validate that the report fees are correct for each service code, ensuring that at a minimum the first and last page of the report are verified. Calculate the fees to verify that the fee in ‘Service Fee/Cross Reference Maintenance’ is correct for the valid number of days in the month.
- Open ‘Post Residential/Inpatient Worklist’.
- Select ‘Individual’ in ‘Individual Or All Units’.
- Select desired Unit in ‘Select Unit(s)’.
- Set the ‘Post Charges From Date’ to desired value.
- Set the ‘Post Charges Through Date’ to desired value.
- Click [Process].
- Validate that the report fees are the same as above.
- If desired, open ‘Client Ledger’ for the client and verify the fees for the date range and services.
- In the next month, place the client on a billable leave on desired date. Return the client from leave on desired date. Discharge the client at least one day after returning from leave.
- Repeat steps 1-17 for the new month of services.
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Topics
• Pro Rated Fee
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