Placement Disruptions Example

Details

• The rate is associated to 2 plans/contracts.
• All care day services that use this rate will consolidate into one claim for the entire month.
• The rate details say the following... "Effective 01/01/2006, for clients who are between the ages of 0 and 18, the contract agency and plan rates will be the following:
  • $10.00 per day for clients on a Hospital Medical or Psychiatric Placement Disruption with a PD1 Procedure Code
  • $11.00 per day for clients on an AWOL Placement Disruption with a PD2 Procedure Code
  • $5.00 per day for clients on a Home Visit Placement Disruption with a PD3 Procedure Code
  • $5.00 per day for clients on an Respite Placement Disruption  with a PD4 Procedure Code"
• A client who is on a Hospital Medical or Psychiatric Placement Disruption for 5 days in a month will be billed at $10.00 X 5 for a total of $50.00.
• A client who is on a AWOL Placement Disruption for 5 days in a month will be billed at $11.00 X 5 for a total of $55.00.
• A client who is on a Home Visit Placement Disruption for 5 days in a month will be billed at $5.00 X 5 for a total of $25.00.
• A client who is on a Respite Placement Disruption for 5 days in a month will be billed at $5.00 X 5 for a total of $25.00.

In addition to the Placement Based Disruption Rules setups, the billing contract must be setup with a rate like the above and the normal rates used to bill and pay for a facility placement. 

The first contract line represents the regular rate paid while the client is in a facility and not on a disruption. The second contract line represents the rate(s) paid while the client is on a disruption.