Occurrence Services Billing Rate (A/R)

Create an Occurrence Rate

1. Navigate to the following path: Finance Setup > Billing Rates (A/R) > Occurrence > History.
2. In the toolbar, click New > Billing Rate Incident Based.
3. Complete the following fields as appropriate:

• Description - Enter the name of the rate. In many cases, rates get changed every year so you might consider using a description like FY04 Rates (FY - Fiscal Year).
• Associated Plans - Select all plan/contracts under the selected payer where this rate will be used. This sub form allows you to share a rate. For example, you may send bills to multiple counties and most counties pay you the same amounts. In this case, you can add the plan/contracts here instead of creating the rate many times.
• Effective Date - Enter the start date of the plan.
• End Date (included) - Enter the date when the rate is ended. (Included) means the date entered is the last date the rate is effective.
• Rate Method - Select a method. Only the rate methods available for the rate type (manual, placement, occurrence, or vacant bed) are available. These are defined by Netsmart.
• Occurrence - Select the type of occurrence. These items are defined by Netsmart.
• Month - Select a month only if this occurrence is based on month. For example, select January to use this rate at beginning of the year.
• Rate Details - In this area, you can put as many lines in the details as necessary but the variables can not overlap to determine the rate. The system validates that you do not attempt to save logic where they overlap, meaning more than one line must not be found for a single service provided.
  • From Age (Incl) - Required variable that is the age of the client at the time of the service. Enter 0 if N/A.
    Note: Incl means included so, if a client is the age identified in this field, the rate will be applied. 
  • To Age (Not Incl) - Required variable that is the age of the client at the time of the service. Enter 99 if N/A.
    Note: Not Incl means Not Included so, if a client is the age identified in this field, or older, the rate will not be applied. 
  • Facility (Empty for Default) - Use if this rate line is to be used for a specific service facility.
  • 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 can be the same or different from the Agency Rate.
  • Procedure Code - This code describes the service being provided, and is 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.