Enter a Manual Services Billing Rate (A/R)

About the Rate Details tab

Here, you can put as many lines in the details as necessary, but the variables cannot overlap to determine the rate. This means that no more than one line can be found for a single service provided. The system verifies that you do not save overlapping variables.

See below for description of each field. Fields with * indicate that in order to see this field, you need to open the rate details sub form in a new window.

• From Age (Incl) - Enter the age of the client at the time of the service. Note: Enter 0 if not applicable.
• To Age (Not Incl) - Enter the age of the client at the time of the service.  Note: Enter 99 if not applicable.
• Min. Time - If applicable, enter the minimum amount of time/duration on a service the client needs to use the listed rate.
• Max. Time - If applicable, enter the maximum amount of time/duration on a service the client needs to use the listed rate.
• Min Year of Enrollment - If applicable, enter the minimum number of years of enrollment on a service the client needs to use the listed rate.
• Max Year of Enrollment - If applicable, enter the maximum number of years of enrollment on a service the client needs to use the listed rate.
• Staff Credentials (Empty for Default) - Optional. If this rate applies only to staff responsible with the selected credentials (such as MD or CSW), you can select credentials. You can enter these values in Table Maintenance. Leaving empty means any credential or lack thereof.
• Staff (Empty for All) - Optional. Designate if this rate line is specific to an individual staff member. 
• Activity Type (Empty for Default) - Optional. If this rate applies to a specific activity type entered in the service, select an activity type. You can enter these values in Table Maintenance. Leaving empty means any credential or lack thereof.
• Encounter With (Empty for Default) - Optional. If this rate applies to a specific encounter entered in the service event, you can make a selection here. These values can be entered in Table Maintenance. Leaving empty means any credential or lack thereof.
• No Show - Select this check box if this rate applies to clients who are marked as no shows on a service entry. myEvolv will create one claim for one unit at the amount entered in this line no matter what time chart is linked to the rate.
• No Show Units - If a service is flagged as a no show, entering in a No Show Unit amount (integer) will multiply the Agency Rate in this line by the number of Units entered and output at that unit count. 
  
  Note: Everything to the right of No Show is used for the bill when a line is found. You can add many rate details for different rates for different ages, different activity types, and so on.
   
• Language Other Than English? - If the event_log field is checked on the service entry, the system will try to bill this line.
• Off Hours? - A service is considered Off Hours when the service occurs outside of the Office Hours set on the Plan/Contract Setup.
• Off Site? - If the event_log field for Off Site is checked on the service entry, the system will attempt to bill this line.
• Is Telehealth - If the event_log field for Telehealth is checked on the service entry, the system will attempt to bill this line.
• Is Holiday Rate - Use if you can bill a different rate on a Holiday. Holidays are defined in Agency Setup > Agency > Agency > Holiday Schedule. 
• Is Interactive Complexity - If the event_log field is checked on the service entry, the system will try to bill this line.
• *Facility (Empty for Default) - Rate lines can be made specific to a facility providing the service allowing you to have different rates by facility.
• Staff Client Ratio - You can pre-setup staff/client ratio records in Table Maintenance. These can be entered on the rate details and system will look at services provided to multiple clients on the same day (using consolidate for a day) and bill the appropriate line for each client.
• Group Rate - If the same staff member is giving the same service to multiple people, myEvolv can charge a different rate.
  
  Note: "Apply Group Rate Rules" in the Rate Settings tab must also be checked when you have Rate Details lines in a single rate setup apply to either Group or Individual services. Otherwise, if “Apply Group Rate Rules” was not checked, the system would bill all rate lines for Group Services and Individual Services.
   
• Overwrite Time Chart - Select a different Time Chart than specified in the Rate Rules section of the Billing Setup form.
• Agency Rate - Enter the regular rate the Agency normally charges anyone for the service.
• Plan Rate - Enter the rate to be charged to the payer for the service. This may be the same as the Agency Rate.
• Procedure Code - Select the code from the list. This is a code that describes the service being provided, used as a way of translating agency services to funder-specific codes.
• Modifiers (Claim) - Funder specific modifiers and often referred to as local use codes. Rate setups allow for 3 different types in most cases. Click here for instructions for adding a fourth modifier. 
• *Enhanced Service Modifier - Single letter entered here will append to the Attending Physician number for Enhanced Services in North Carolina.
• *Modifier for Additional Services - If multiple services are provided in a day and you need to append an additional services modifier (59), enter here. myEvolv will add this modifier to additional services billed in the day based on when the services occurred in a day. By default, this would apply to any service and staff, however there is a setting on the Agency Information screen that tells the system to enforce this modifier only if the same staff provides the service. Do not use this modifier if you are using the setting on the Receiver to output enhanced service modifier.
• Rate Code Override - If you are outputting rate code in your claims (837i and typically NY only), entering a rate code here will supersede the Rate Code entered on the Rate Header.
• Revenue Code Override - If you are outputting revenue code in your claims (837i), entering a rate code here supersedes the Revenue code entered on the Rate Header.
• APG Override - Do not use on Manual Service rates. This field should only be used on E/M rates for NY.

About the Consolidation Rules Tab

• Consolidate Services - Select this check box to consolidate services for a time period. For example, you may want the system to create one claim for an entire day's worth of services provided under this rate. Selecting this option enables other selections on this tab.

• Consolidate for a Period - Select a period of time to consolidate the claim such as day, month, or calendar year.
• Through Date Supplied - When you select this option, the claim will read a from date and through date (such as 1/1/17-1/2/17).  If this option is not checked, the claim date will read only the date of service (such as 1/1/17).
• Rate Applies to a Full Period - When you select this option, the rate used from the Rate Details line will apply to the entire Consolidation period. If not selected, the rate applies to each individual unit and those units are added up for the period selected.
  • Use Min/Max Units for Period Qualification - Consolidate all services for a day. In order to bill, you must have a certain number of units. 
  • Min Number of Units - Enter the minimum amount of units required to bill. 
  • Max Number of Units - Enter the maximum amount of units required to bill. 
• Min Consolidated Time - In order to bill, you must have spent at least this much time combined during the course of the period providing the service.
• Max Consolidated Time - In order to bill, enter the maximum amount of time you can spend during the course of the period providing the service.
• Consolidate only if Consecutive Dates - Consolidation rules only apply if the services are provided on consecutive dates. This only applies to consolidation periods that are NOT a Day.
• Pre-Consolidate Services by Day - If multiple attendance records are entered for a day, consolidate them into one and sum the durations before proceeding with standard rules and consolidations.
  • Minimum Pre-Consolidated Time - In order to bill, you must have this minimum number of pre-consolidated time for the day.
  • Maximum Pre-Consolidated Time - In order to bill, you must not have more than the maximum number of pre-consolidated time for the day.
• Apply Authorization After Consolidation - When you select this option, the billing authorization from the funder is applied after all consolidation has happened.
• Output Form/Through Date Always? - When checked, on outputs the system will output both the From Date and Through date on the claim regardless of consolidation. For example, if consolidate for a day is set and the date of service is 1/1/2018, the date on the claim will output as 01/01/2018-01/01/2018.

About the Rate Settings Tab

• Time Chart - Select the time chart. Click here for more information. 
• Apply Time Chart to Individual Services - Select this option to apply the time chart to each service before the service is consolidated, then add the units together as part of the consolidation process. Click herefor detailed examples. 
• Unit Output Type - The Unit Output type (837) to be used on the output such as minutes, days, and unit.
• Time Chart for Output - Time chart to use for claim output. For example, say you bill Medicaid in 1 minute units, but Medicare you bill as a single unit. You create the charge in Minutes to Medicare, i.e. $1.50 per minute, but the claim must go out as 1 unit. In this example, you would have "Time Chart" as Every Minute = 1 Unit, but in "Time Chart for Output," you would have Time Doesn't Matter - Each service is 1 Unit. 
• Create One Unit per Service Line - No matter what time chart or consolidation you are using, when the claim and service line get created, the service line is always 1 Unit.
• Include Indirect Service Time - Selecting this option includes time spent on planning, travel, and so on. This is typically setup on the service form to calculate the total time on planning, travel, and more and place into the duration_other field. When this box is checked, the system will add the duration and duration_other fields together before calculating charges and units.
• Include Participating Staff Notes Durations - This option requires an event has multiple notes. Each staff member can put in the note of the duration for services performed. The system will add up all entries and add to the duration of the service. 
• Divide Group Service Time By Attendees -If checked for billed services, time billed is the time that would normally be billed divided by the total number of participants in the activity. Note: You should not use this with the Event-Definition flag: time divided by number of attendees.
• Use Total Time for Finding Procedure Code - Only available if you select to include indirect service time. If you select this option, the service will calculate both the indirect and direct service time to determine the appropriate procedure code. 
• Carve-Out Services List - Identifies a list of services services that cannot be billed simultaneously (with the service being configured).
  Note: The list is configured here: Finance Setup > Payer/Contract Setup > Payers > Carve-Out Services. 
• NYS Full Day Rate - This applies specifically to NYS Day Habilitation billing needs. This identifies that this Rate is the 'Full Day' Rate. For example, Day Hab billing requires of these three: Full Day is min 4 hours and 2 QS, Half Day is Min 4 Hours and only 1 QS, Half day is 2-4 hours and 1 QS. This requires 3 History records under the Rate. You need to designate the true Full Day as a NYS Full day so the system can distinguish the 4 hour minimum rate on the half day with 1 QS. Otherwise, the system will not let you save overlapping Rate Histories when the Min and Max Consolidated times are the same in multiple histories under the same rate.
• Apply Holidays Rule - If this is checked, the system will verify that the rate details entered without 'holiday' setting will apply on non-holiday days (as determined in the Agency Holiday Schedule). This refers to the 'Is Holiday' checkbox under the 'Rate Details' tab.  If you have a Rate Details line for a Holiday Rate and another line without the "Is Holiday" line checked, if you do not check this "Apply Holidays Rule" box the system will create 2 claims on a holiday.
• Output End Date as Claim Date - When checked, myEvolv will output the "From Date" as the claim date. If a service spans dates, say 1/1 through 1/3, with this checkbox the claim date will be 1/3.
• Output Last Date of Period as Claim Date -  If this is selected, the Claim Date on the Output will be the last date of the Consolidation Period regardless of what the last billable date of service is. For example, in November, the last date of service that was billable is Nov 27. With this checkbox, the date outputted would be Nov 30 as this is the last day of the period "Calendar Month". This logic applies to all consolidation periods, i.e. Calendar Week, Calendar Year, etc. 
• Apply Group Rate Rules - Must also be checked when you have Rate Details lines in a single rate setup apply to either Group or Individual services. Otherwise if “Apply Group Rate Rules” was not checked, system would bill all rate lines for Group Services and Individual Services. 

About the Qualifying Services Rules tab

1. Complete the following fields as appropriate:
   • Qualifying Service Required - Select this check box to require a qualifying service. This identifies that in order to bill the rate being configured, other services must be provided.  
   • Qualifying Service same day as billed - This indicates that a Qualifying Service only counts toward the requirement if it occurs on the same day as the service being billed.  
   • Every QS List Required - If this is selected and you have multiple QS lists in this sub form, in order for the system to create a claim there must be QS from all lists and settings in this subform.
   • Qualifying Service same program as bill - This indicates that, in order for the Qualifying Service to count toward the requirement, it has to be provided in the same myEvolv Program. 
   • Use Service Date From First QS on Claim Output - If checked, the 837 will output the date of the first qualifying service as the service date on the claim.
2. Under the Additional Qualifying Services section, you can optionally add qualifying services to this billing rate. This was specifically designed for NY PROS billing, but can be used for other types of business. For PROS IR services, the first QS area is used to calculate the unit cap for the day and the second QS area checks to see if a separate applicable IR service is provided in the Calendar Month

About the Period Break for Consolidated Services Tab

In the Consolidation Rules tab, you can consolidate services for a time period. For example, you may want the system to create one claim for an entire day's worth of services provided under this rate. In this tab, you can select the following scenarios to break a consolidation period to a create a new claim.

• Break When Rate Amount Changes - Select this check box to create a new service line when the rate amount changes. This would occur when you have multiple rate details lines in this rate setup.
• Apply Rate from Period End - If the period does not break when rate changes, checking this means that the rate from billing period end will be applied. Leaving unchecked means that the rate as of period start will be used. For example, for a Calendar Month consolidation where you have rate details lines for different age ranges, when a client's birthday happens during the month which changes the rate based on your rate details setups, checking this box will use the rate detail line applicable on the last date of the month for the entire claim. if this is not checked, the system will use the rate detail line for the entire month applicable to the client's age at the beginning of the month.
• Break when Facility Changes - Select this check box to create a new service line when the facility changes within the consolidation period. 
• Break by Place of Service - Select this check box to create a new service line for each service with a different place of service code. 
• Take POS From Longest Service - By default, the claim takes the Place of Service code from the first service line. You can select his check box to have the claim instead take the Place of Service code from the longest service.
• Break By Staff - Select this check box to create a new claim for each staff member when different staff provide the same service to the same client that is being billed.
• Do Not Break When Location ID Changes - Select this check box when consolidating multiple services in different programs that use this rate where the different programs may have different billing provider Location ID's. By default, myEvolv breaks claims by location ID, however this setting overrides this functionality. There is a setting on the Location ID setup form that tells myEvolv which Location ID takes priority over the other in this situation.
• Break by Authorization - Select this check box to create a new service line when multiple authorizations are present for this service. Without this checkbox checked, myEvolv will attempt to create a single claim attaching only one fo the authorizations. if there are not enough units left on that single auth, the claim may either be suppressed or held if using the setting to hold if no authorization.