Revenue Setup

Details

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.