Plan/Rate Information
The conventions of setting up rates for Self Pays follows the same logic as Payer Plan/Contracts Setup and Plan/Contract Rates setup. Instead of separate areas for these, they are all contained on the same form.
Create Multiple Self Pay Plans
Multiple Self Pay plans can be setup for those agencies that need to regionalize self pay processing.
- Click New.
- Select Self Pay Plan.
- Enter appropriate information for this plan.
- Click Save.
Fields
- % Will Pay
- If a contract is only responsible for paying a percent of the rates, enter that percent here. This is mostly used for private insurance billing. It would apply if, for example,clients in the contract only pay 80% of the Agency's contract/plan rate for all services.
Only do this when it applies to all who are designated to this contract. - If a percent applies to individual clients, co-pay and deductions, this is entered in Benefit Assignments Co-Pay and Claim Deduction.
- If a contract is only responsible for paying a percent of the rates, enter that percent here. This is mostly used for private insurance billing. It would apply if, for example,clients in the contract only pay 80% of the Agency's contract/plan rate for all services.
|
Account |
Dr |
|
Agency Rate for Service |
$100 |
|
Contract will pay |
80% |
|
Expected Payment |
$80 |
- In Contract - Automatically flagged for Self Pays.
- Is Active - Will be available for assigning to clients when checked.
- Is Additional Self Pay Plan - Flag noting whether this plan is in addition to the regular self pay plan.
- Allow to change dates on claims - Flag if you wish to allow users to change the dates on a claim if the claim has not been Marked as Sent. In billing, when claims are created via batch, after generating the output, marking as sent will lock claims..
- Name/Description - What will appear in pick lists and listings that use the contract.
- Scheme - The programs and services selected under the scheme will apply to this contract. The one selected will then produce the programs and services defined in that Scheme in Plan/Contracts Rates. They will appear in Revenue Setup [Billing] and Expenses Setup [Accounts Payable].
- Submitter Information - Select who is supplying this billing to the Receiver.
- Receiver Information - When a bill is sent under this contract, it will be sent to this Receiver selected who will forward it this Funder.
- Contra Account - GL Account used when there is a remainder and it is not written off.
- Bad Debt Expense Account - Select the expense account you wish to use for bad debt.
- Write-Off System Adjustment Account - This corresponds with the Write-off GL account in the Remittance Screen. This account was setup in Chart of Accounts. When Write-off remainder is used in the previous selection or remainder of the claim is written off during remittance processing, the GL Revenue code used to offset that write off. In this situation, the Write-off expense defined below will be used as the DR and this account would be used as the offsetting revenue credit. With this, you have the ability of using a different revenue account for these types of write-offs as opposed to those defined previously.
|
Account |
DR |
CR |
80% Plan Will Pay - Billed Payer $100 |
|
AR |
+[100] |
|
Bill $100 |
|
Revenue |
|
+[100] |
|
|
Account |
DR |
CR |
Receive check for $60 of $100 expected |
|
Temp-Unallocated |
-[60] |
|
Paid 60 |
|
AR |
|
-[60] |
100 - 60 = 40 |
|
Write-Off Account |
-[20] |
|
$100 - $80: $20 balance |
|
AR |
|
-[20] |
20 - 20= 0 AR balance |
- Liability Account for Void Claims -This is the Holding Area/Liability Account that is used. Void Claim in Remittance Area. This amount will be deducted the next time a bill is paid.
|
Account |
DR |
CR |
|
Revenue Account |
+ |
|
|
Liability Account |
|
+ |
- AP Account for Credit Invoices - If a check needs to be cut to cover this paid amount, setup AP account here to off set transaction. This account was setup in Chart of Accounts.
- Overpayment Account - The Account to be used to allocate this overpayment against must be entered here (this can be any account the agency chooses).
- The following remittance action will use the account entered here.
- OP1- Allocate Overpayment to Overpayment Account - Typically this would be a Revenue or Liability account so as to track the $ separately. To reduce the liability or return the revenue, one would enter (debit) a manual invoice against the account that was credited.
Tabs
If you are creating a new self pay contract, you must save then edit the record to get to the following tabs.
- Revenue Setup
Revenue represents the claims that will be produced base on the services provided by your agency for you to receive payments from your agency's Payors.
To add an entry, click the blank page icon at the bottom of the program listing.
To modify an entry, click the Folder Icon.- Program/Service - Program & Service combination for the rate you are defining. This is read only and is based on which folder icon/new icon you selected in the previous screen.
- All Program Modifiers - Flag if this rate encompasses all program modifiers. In other words, this rate will apply no matter which program modifier is entered for a client.
- Program Enrollment Modifier - Use only if All Program Modifiers is NOT flagged. Select the appropriate modifier from the picklist.
- Billing Rate - The billing rate associated to this combination of program/service and possibly individual modifier. This rate can be any type of service
- Authorization Required - Flag if a valid Billing Authorization is required. If flagged, the system will still generate the claim, however it may be marked as a Held Claim A claim that is produced by the system, however is held due to 1 of 5 reasons. 1. Authorization not Approved, 2. No Valid Authorization Found, 3. No Primary Diagnosis Found, 4. No Policy Number 5. Service Not Approved. with reason number 2 if the flag in the next field is checked.
- Hold Claim if No Authorization - Flag if a claim is to be Held. If unflagged, the system will not produce a claim if there is no valid billing authorization on file.
- Supervisor Approval Required - Flag if the supervisor must mark a service as approved before a claim is produced.
- Service Authorization Required - If flagged will not produce a claim if there is no Service Authorization on file. NOTE: Do not use this flag unless you use the Service Authorization feature and are instructed to do so by a Netsmart Representative.
- Placement Disruption Rule - Select an appropriate placement disruption rule if applicable to the rate. This is only used for care day rates.
- Overwrite Modifier 1 - Additional modifiers that a funder would require to correspond to a procedure code (HFCA 1, 2, 3) and used only for HIPAA transactions.
- Rev GL. Account - Select your Gl Revenue Account. Can be any account in your system.
- Accrued AR Account - Select your Gl Accrued AR Account. Can be any account in your system.
- A/R GL Account - Select your Gl AR Account. Can be any account in your system.
- Rev. Cost Center - Select the appropriate Cost Center.
- Is Active - Flag whether this rate is active.
- Expenses Setup
Expenses are how the system will generate payments you make to your Vendors. myEvolv will, based on the setup of this area, create invoices for payments. Invoices can then be used to create A/P Checks for payment to the vendor.- Program/Service - Program & Service combination for the rate you are defining. This is read only and is based on which folder icon/new icon you selected in the previous screen.
- All Program Modifiers - Flag if this rate encompasses all program modifiers. In other words, this rate will apply no matter which program modifier is entered for a client.
- Program Enrollment Modifier - Use only if All Program Modifiers is NOT flagged. Select the appropriate modifier from the picklist.
- Payment Rate - The payment rate associated to this combination of program/service and possibly individual modifier. This rate can be any type of service.
- Authorization Required - Flag if a valid Payment Authorization is required. If flagged, the system will still generate the claim, however it may be marked as a Held Claim.
- Hold Claim if No Authorization - Flag if a claim is to be Held. If unflagged, the system will not produce a claim if there is no valid billing authorization on file.
- Service Authorization Required - If flagged will not produce a claim if there is no Service Authorization on file.
Do not use this flag unless you use the Service Authorization feature and are instructed to do so by a Netsmart Representative. - Placement Disruption Rule - Select an appropriate placement disruption rule if applicable to the rate. This is only used for care day rates.
- Rev GL. Account - Select your Gl Revenue Account. Can be any account in your system.
- Accrued AR Account - Select your Gl Accrued AR Account. Can be any account in your system.
- A/R GL Account - Select your Gl AR Account. Can be any account in your system.
- Rev. Cost Center - Select the appropriate Cost Center.
- Is Active - Flag whether this rate is active.
- Vacancy Billing Setup
NA for Self Pays