Facility Specific
Below demonstrates a placement service rate where the each facility has its own rate.
Details
- The rate is associated to 2 plans/contract
- All care day services that use this rate will consolidate into one claim for the entire month.
- Separate claims will produced in periods where the client changes facilities
- The rate details say the following... "Effective 01/01/2001, for clients who are between the ages of 0 and 98, the contract agency and plan rates will be $86.00 per day for clients in the 'Residential Facility', and Plan and Agency rates will be $95.00 per day for clients in the 'A Different Residential Facility'. The procedure code on all claims produced will be 7001. Claim Modifiers will be added to 837 transactions."
- A client who is in the 'Residential Facility' in the entire month of June will be billed at $86.00 X 30 for a total of $2,580.00.
- A client who is in the 'A Different Residential Facility' in the entire month of June will be billed at $95.00 X 30 for a total of $2,850.00.
- A client who has moved from the 'Residential Facility' to the 'A Different Residential Facility' in the month of July (say July 15) will have 2 claims produced. One claim billed at $86.00 X 14 and another claim billed at $95.00 X 17.
- Placement Disruption Rules may affect any claims produced for days billed. However, the below does NOT demonstrate placement disruptions billed at a different rate.