Configuring Billing Rates

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The last step in the setup process requires you to enter rates for each procedure for each program.  Those rates can be updated as needed in the future, and AWARDS keeps a history of previous values.

To configure billing rates, complete the following steps:

    1. From the AWARDS Home screen, click Administration from the left-hand menu, and then click Fiscal.  The Fiscal fly-out menu is displayed.
    2. Click BillingBuilderThe BillingBuilder Menu page is displayed. 

    1. Click Billing Rates.  The Billing Rates page is displayed. 

    1. Click the Payer drop-down arrow and select the appropriate payer.

  TIP: If "Self Pay" is selected as the payer, all invoices for that payer will be created with the procedure rate entered during this procedure.  Any self pay rate entered within a client's entitlement records will not be used if a procedure rate for the self pay payer exists in the system. 

    1. Click the Program drop-down arrow and select the program for which the billing rates are to be configured.

  TIP: If the "All programs with this billing type use the same billing rates" checkbox was checked off during the process of configuring the billing type, then the rates set for this program will apply to all programs in the billing program group.

    1. Confirm that the Database selection is "Data Entry" (the default).
    2. Click CONTINUE.  The Select Effective Date page is displayed.

  NOTE: Any existing billing rates on file for this payer and program are displayed on this page under "Billing Rates on File."  

    1. Click the Procedure Code drop-down arrow and select the procedure for which the billing rates are to be configured.
    2. Click the Effective Month/Year drop-down arrows and specify the month and year in which the billing rates became effective.
    3. Click Create.  The Billing Rates page is displayed. 

  NOTE: The Month and Year fields on this page indicate the effective date of the billing rate as selected on the previous page. The Description field displays the procedure name that was created when it was configured. The Proc Code displayed is the procedure code assigned to the procedure's name when it was configured.

    1. In the Billing Rate field, enter the rate for the selected procedure. 
    2. In the Remit Rate field, enter the expected rate for the selected procedure.

  NOTE: This is optional.

    1. Click the Tiered Qualifier checkbox if different rates are in effect for the same procedure based on different credentials.  If checked, the page refreshes and a checklist of credentials is displayed.  Each credential will have corresponding HCPCS Modifier and Rate fields.  Click the checkbox for any credentials being billed and type the different HCPCS modifiers and rates in the corresponding fields.  

  TIP: For example, if a counseling session is billed for $100 if it is provided by a social worker and $150 if it is provided by a psychiatrist, enter both rates here.  AWARDS will then apply the correct rate based on the staff member's credentials as entered in the Human Resources module, Staff Information feature.

    1. Click SAVE.  The rate information is saved and displayed on a confirmation page.
    2. Click Return to Data Entry to return to the Select Effective Date page, and then repeat steps 8 through 15 until all procedures for the selected billing type have rates entered for them.
    3. Repeat steps 1 through 16 until all procedures for all billing types have rate information entered for them.

The process of configuring billing rates is now complete.

  TIP: If it is later necessary to update or delete billing rates, complete steps 1 through 10 above, and then either make the necessary changes and click Save, or click Delete to delete the rates entirely.

If a billing rate has changed for a particular procedure due to your payers fee schedule changing, simply choose the procedure and a new effective date, click Create, enter the new rate, and then save the page.  The old billing rate is then archived.  AWARDS will assign the new rate to any services with a service date on or after the effective date of the new rate, and will use the old rate for service dates before the effective date of the new rate.

To modify an existing rate, choose the procedure and the existing effective date, click Update, make changes as needed, and then save the page.  This process will replace the original rate with the newly entered information.