Client Billing Setup PARTICIPANT S GUIDE

Transcription

1 Client Billing Setup PARTICIPANT S GUIDE

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3 INTEGRATED SOFTWARE SERIES Client Billing Setup PARTICIPANT S GUIDE

4 Version 3 - September 2011 Copyright Interactive Financial Solutions, Inc. All Rights Reserved. Integrated Software Series Client Billing Module Setup Participant s Guide. This workbook, as well as the software described in it, is furnished under license and may be used or copied only in accordance with the terms of such license. The contents of this workbook are furnished for informational use only, are subject to change without notice, and are provided without any express, statutory, or implied warranties. Interactive Financial Solutions, Inc. assumes no responsibility for any errors or inaccuracies that may appear in this workbook. The example companies, organizations, products, domain names, addresses, logos, people, places, and events depicted herein are for demonstration purposes only and are not intended to refer to any actual organization. Integrated Software Series and Solana are copyrights of Interactive Financial Solutions, Inc. MRDD Solutions and the MRDD Solutions logo are registered trademarks of Interactive Financial Solutions, Inc. Other product and company names mentioned herein may be the trademarks of their respective owners.

5 Contents Client Billing Module Setup Lesson 1: Setup Overview... 9 Adding a New Item Modifying Items Deleting Items Creating a Listing Lesson 2: Service Types Exercise1 Service Types Lesson 3: Funding Sources Exercise2 Funding Sources Lesson 4: I/S Account Codes Exercise3 I/S Account Codes Lesson 5: B/S Account Codes Exercise4 B/S Account Codes Lesson 6: CL Cost Centers Exercise5 Cost Centers Lesson 7: Options Lesson 8: Groups Exercise6 Groups Lesson 9: Counties Exercise7 Counties Lesson 10: Places of Service Exercise8 Places of Service Lesson 11: Providers Exercise9 Providers Lesson 12: Billable Transaction Sets Lesson 13: Facility Type Codes Exercise10 Facility Type Codes Lesson 14: UCRs Exercise11 UCRs Lesson 15: Service Type Conversions Exercise12 Service Type Conversions Lesson 16: Departments Exercise13 Departments Lesson 17: Holiday Times Exercise14 Holiday Times Lesson 18: Premium Times Exercise15 Premium Times Lesson 19: Custom Billing Formats

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7 Client Billing Module Setup As part of your purchase of the Client Billing Module, your assigned software implementation specialist completed the initial module setup as it existed at the time of installation. The purpose of this training session is two-fold: To review your organization s setup options To show you how to make any setup changes for the future, beyond initial installation setup 7

8 Agenda. Agenda This session will cover the following topics: We will discuss this topic: On page: Lesson 1: Setup Overview page -3-9 Lesson 2: Service Types page Lesson 3: Funding Sources page Lesson 4: I/S Account Codes page Lesson 5: B/S Account Codes page Lesson 6: CL Cost Centers page Lesson 7: Options page Lesson 8: Groups 1-3 page Lesson 9: Counties page Lesson 10: Places of Service page Lesson 11: Providers page Lesson 13: Facility Type Codes page Lesson 12: Billable Transaction Sets page Lesson 14: UCRs page Lesson 15: Service Type Conversions page Lesson 16: Departments page Lesson 17: Holiday Times page Lesson 18: Premium Times page Lesson 19: Custom Billing Formats page

9 Setup Overview Lesson 1: Setup Overview You will find all of the setup items located under the Setup submenu of the Client Billing menu. This is where all of the setup specific to your agency is located and from which other areas of the Client Billing Module will pull from for data needed to most efficiently utilize the billing features. The method in which you manage each of the setup items in the Client Billing Module is consistent from item to item. For example, the way you add, edit and delete items throughout the software is always the same.. 9

10 Setup Overview. Adding a New Item Tip You can add an item as you are using the software by pressing F7. To add a new item: 1. Click Add. The dialog box will become active. 2. Enter the required information and click Save. 10

11 Setup Overview Modifying Items Tip You can modify an item as you are using the software by entering its code in a lookup box or highlighting it in a list box and pressing F8. To modify an item: 1. Find the item you want to modify. 2. Click Edit. 3. Modify the information as needed and click Save.. 11

12 Setup Overview. Deleting Items Tip If an item is in use or has any history, you will not be able to delete it. Most items do have the option to make the item inactive (by clearing the Active check box). Doing so will prevent the item from being used in the future. If you find that you need to use the item later, you can always make it active again. Otherwise, you can modify the description of the item to include the words Do Not Use. To delete an item: 1. Find the item you want to delete. 2. Click Delete. 3. Click Yes to delete the item (or No to cancel). 4. Click OK to close the confirmation window. 12

13 Setup Overview Creating a Listing To create a listing of items: 1. Click Listing from the dialog box. You will see a print preview of the listing: 2. From here, you can print the listing or save it to a standard format by pressing CTRL + E. For details on saving to other formats, see the Getting Started User s Guide. 3. Click the X in the upper right corner to close the print preview.. 13

14 Service Types. Lesson 2: Service Types A service type refers to the type of service being performed and is the complete list of services provided by an organization. A service type can be one of four types: worked time direct, units, non-worked time and worked time indirect. The non-worked time and worked time indirect service types are only used if you are merging time over to the Payroll Module to pay your employees for all time worked. The billing codes for each service type are set up at the funding source level. Each service type can be used by multiple funding sources and have different bill codes associated with it depending on each funding source s billing requirements. When thinking about what service types your agency provides its clients and how they relate to the funding source and then eventually to the client there are a few things to remember. First, you may not need a specific service type for every bill code you bill. Meaning that if you have a day habilitation service type and you provide day habilitation for two clients with different bill codes (for example, AHA and DSRV), both bill codes could go under your service type for day habilitation as long as each client could only have one of the bill codes during a contract period. Therefore if client one has a bill code of AHA and client two has a bill code of DSRV both of these bill codes can be under the day habilitation service type. Note, this would not be true if client one had both AHA and DSRV bill codes. This would necessitate two separate service types because the client can have both bill codes simultaneously. Service Type: Day Habilitation Service Type: Homemaker/ Personal Care Service Type: Transportation Service Type: Direct Care Bill Code: AHA Bill Code: ABC Bill Code: CHA Bill Code: CBA Bill Code: DSRV Bill Code: QRST Bill Code: DHA Bill Code: TSRQ Before you can add a service type, you may need to set up these items: Balance Sheet Account Codes Income Statement Account Codes Job Titles* (see the Payroll Module User s Guide) Payroll Cost Centers* (see the Payroll Module User s Guide) * If you are also using the Payroll Module and will be merging client billing transactions to it. 14

15 Service Types To add a new service type: 1. On the Module menu, point to Client Billing and then point to Setup and click Service Types. 2. Click Add from the Service Types dialog box. 3. Type or select the following information as required. Code* Type or select: A unique, alphanumeric code for the service type. This code will be used in service type lookup boxes throughout the software. Description* Type A meaningful description of the service type. This description will appear in service type list boxes throughout the software. Work Time Direct - time spent directly with a client. Work Time Indirect - time worked, but not directly with a client (for example an inservice training session). Non-Work Time- paid time off (time for which the employee is paid, but does not actually work, for example, jury duty, vacation, personal and holiday). Unit - a type of service that is billed by the unit, such as mileage and social work, and is not usually related to time.. 15

16 Service Types. Default BS Account Default IS Account Job Title Cost Center Pay Rate Level Billable Use Begin/End Time Work Performed at Cost Center Don t Send to Payroll No Error Checking Type or select: The default balance sheet (accounts receivable) account. If a default balance sheet account is also set up in the funding source, this one will override it. If you enter a default BS account, the software will automatically fill it in during contract detail entry, thus saving data entry time. You can then override it at the contract detail level if needed. The default income statement (revenue) account. If a default income statement account is also set up in the funding source, this one will override it. If you enter a default IS account, the software will automatically fill it in during contract detail entry, thus saving data entry time. You can then override it at the contract detail level if needed. The job title code (or press F2 to browse for it) to use if merging to the Payroll Module and Use Job Title From Service Type is selected from the Job Title Type list box on the Payroll tab of the Options dialog box. The payroll cost center s code (or press F2 to browse for it) to use if merging to the Payroll Module and Use From Service Type is selected from the Cost Center Type list box on the Payroll tab of the Options dialog box. The pay rate level (1, 2, 3, 4, 5, 6, 7 or 8) to use if merging the employee s time to the Payroll Module. If you select a force pay level during time transaction entry, it will overwrite the pay level selected here. If you enter a number other than 1-8, you will receive an error message when you try to merge a time transaction using this service type to the Payroll Module. If this service type is billable to a funding source. To enter start and end times during time transaction entry, otherwise you will enter the total hours. To remit city taxes for an employee using the Payroll Module cost center s indirect city tax instead of the city tax. Refer to the Payroll Module User s Guide for details. If merging transactions to the Payroll Module and you do not want to merge any transactions for this service type to the Payroll Module. To turn off error checking for this service type during data entry. 16

17 Service Types Night Service Type or select: This is a legacy field that is no longer used. Include on ODMRDD Service Report *This field is required. If the service type should appear on the ODMRDD Services Report that can be used to key in data to the ODMRDD portal for determining a client s billing rate. 4. If you are merging time to the Payroll Module and you need to set up wage types for this service type, click the Prim (HolA, HolB, HolC, Prim OT, HolA OT, HolB OT or HolC OT) tab at the bottom of the window and enter a wage type code (or press F2 to browse for it) in each of the boxes as needed. For details on wage types refer to the Payroll Module User s Guide. Repeat this process for each of the remaining tabs as needed. Primary (Prim) is regular worked time. Primary Over Time (Prim OT) is for regular overtime worked. Holiday (Hol A, Hol B, Hol C) is for time worked on a specified holiday. You can set up your holiday schedule and let the software select the appropriate wage type code or you can override it during data entry by entering A, B or C as the second character in the Force Wage Code box. Holiday Over Time (Hol A OT, Hol B OT, Hol C OT) is for overtime worked on a specified holiday. You can set up your holiday schedule and let the software select the appropriate wage type code or you can override it during data entry by entering an X, Y or Z in the Force Wage Code box. Within each tab is a box for No Premium, Premium A, Premium B, Premium C and Premium D, which allows the service type to have premium/shift differentials associated for payroll processing. Enter the wage type that is associated with that service for that type of wage. You can have up to four premium wage types. You can enter your premium times in a schedule or you can override them during data entry by entering an A, B, C, D in the Force Wage Code box. For example, for a service called direct care, on the Prim tab in the No Premium box, you would typically enter the wage type code for regular hours. On the Hol tab in the No. 17

18 Service Types. Note Premium box you might, enter the wage type code for holiday worked. Then on the Primary OT tab in the No Premium box, you might enter the wage type code for overtime and on the Hol OT tab in the No Premium box, you might then enter the wage type code for holiday worked overtime. If you do not differentiate between holiday and holiday worked then you would enter the wage type code for holiday worked in the No Premium box on both tabs. The premium boxes are only used, if you offer a bonus premium/shift differential for employees who work specified hours. This could be for a second or third shift or possibly a weekend bonus. The Prim Formulas and Hol Formulas tabs are no longer used. 5. When finished, click Save and then click Close to exit. Exercise 1: Service Types Print a listing of your service types for your records. 18

19 Funding Sources Lesson 3: Funding Sources The funding source represents the organization you submit the bills to for the services performed for your clients in order to receive payment for those services provided. Within each funding source you can select the service types that apply to that particular funding source. For each applicable service type, you will set up the billing codes associated with the service type as defined/required by the funding source. Within the funding source, you will also set up the rejection codes and the reference information for all the entries that will be made in the General Ledger from Client Billing. The chart below gives you an overview of how funding sources, service types and bill codes interrelate. Funding Source: State Funding Source: County Service Type: Day Habilitation Service Type: Homemaker/ Personal Care Service Type: Transportation Service Type: Direct Care Bill Code: AHA Bill Code: ABC Bill Code: CHA Bill Code: CBA Bill Code: DSRV Bill Code: QRST Bill Code: DHA Bill Code: TSRQ Before you can add a new funding source, you may need to set up these items: Phone Number Descriptions (See the General Ledger Module User s Guide) Address Descriptions (See the General Ledger Module User s Guide) Service Types Balance Sheet Account Codes Income Statement Account Codes Patient Liability Accounts (See the General Ledger Module User s Guide). 19

20 Funding Sources. Contract Adjustment Accounts (See the General Ledger Module User s Guide) Facility Type Codes Providers To add a funding source: 1. On the Module menu, point to Client Billing and then point to Setup and click Funding Sources. 2. Click Add from the Funding Sources dialog box. 3. Type or select the following information on the Info tab as required. Code* Name* Sort Name* Address 1 and Address 2 City, State, Zip Code Contract Number Type or select: A unique, alphanumeric code for the funding source. The name of the funding source. The name you want to use for the funding source in sort lists. The street address of the funding source. The city, state and zip code of the funding source. Your organization s contract number with the funding source. If you want the system to create new claims if the provider on prior authorization number changes within bill dates, you need to enter <SPECIALCLAIM2> as the contract number. 20

21 Funding Sources Fiscal Year Begin Ratio Handling First Day of Week Type or select: The month in which the fiscal year begins for this funding source. New Method - To use the ratio handling options on the G/L Integration tab. This is the option that Solana recommends that you use, if the funding source requires recognition of ratios. No Divide - If your funding source does not require recognition of ratios (that is all services have a ratio of 1:1). The remaining options are for backwards compatibility purposes only. The first day of the week for the funding source. * This field is required. 4. Click the Phone tab. 5. Type or select the following information as needed: Type or select: Phone Numbers Up to three phone descriptions and the associated numbers. Addresses Up to three descriptions and the associated addresses.. 21

22 Funding Sources. 6. Click the Service Types tab. 7. Click New. 22

23 Funding Sources 8. Select the service type(s) appropriate to this funding source and click OK: If you want to: Highlight all the service types Highlight consecutive rows Highlight multiple service types Clear the highlighted service types Reverse the selection of service types Then: Click Select All. Hold SHIFT and click the top and bottom service type. Hold CTRL and click each service type Clear All. Invert -OR- press the SPACEBAR. All service types currently highlighted will be cleared and vice versa. After you have added the service types to the funding source, you need to modify each one to set up its bill codes.. 23

24 Funding Sources. 9. Highlight a service type and click Edit. 10. Click New. 24

25 Funding Sources You will see the Billing Codes dialog box: 11. Type or select the information below as required. Code* Type or select: A unique, alphanumeric code for the billing code. This code will be used in look up boxes throughout the software. Description* Billing Increment Rounding Precision A meaningful description of the billing code. This description will be used in look up boxes throughout the software. Day - 24 hour billing increments Quarter Hour - 15 minute billing increments Hour - 60 minute billing increments Unit - a non-time billing unit, such as mileage Half Hour - 30 minute billing increments Minute - 1 minute billing increments Whole Increment - When rounding use whole increments. Half Increment - When rounding use half increments Quarter Increment - When rounding use quarter increments No Rounding - Use actual number entered. 25

26 Funding Sources. Rounding Method Billing Category Use Bill Rounding Type or select: Up - For partial increments, round up to the next Rounding Precision selected. For example, if the increment is hours and the precision is whole and you entered 3 hours and 2 minutes, the system would round to 4 hours. Down - For partial increments, round down to the next Rounding Precision selected. For example, if the increment is hours and the precision is whole and you entered 3 hours and 59 minutes, the system would round to 3 hours. Standard - For partial increments, round up when the partial increment is greater than or equal to half the selected increment and down when it is less than half the selected increment (to the next Rounding Precision selected). See Appendix D of the Client Billing User s Guide for details. Regular - If this bill code is for the regular service type. Reserve - If this bill code is for reserve hours/units available if the client runs out of regular hours/units. If you use reserve, you must also have a corresponding bill code for regular. To round the client s entire bill for that bill code. For example, if the billing increment is hours and the rounding precision is whole hours and you have created a bill for a month, the software will round the number of hours for the entire month instead of for the day. Use Global Rate Use Global Limit Summarize on 837 Claims If the rate is the same for this service type/bill code for all clients. Otherwise the rate will be set at the contract-level, per client. If the global limit is the same for this service type/bill code for all clients. Otherwise the limit will be set at the contract-level, per client. To summarize the claims on the 837 file so that there is only one service item (detail line) per client per bill code per month instead of per day. 26

27 Funding Sources Include Service Line Rendering Provider Single Claim Per Day Type or select: If you want to include the employee s rendering Provider ID 1 and/or Provider ID 2 in service line of the 837 electronic file, select the appropriate option: SSN/Provider 1: This option will put the employee s SSN in the 2420A NM1 09 loop of the 837 file and the provider number from Provider 1 in the 2420A REF 02 loop. SSN/Provider 2: This option will put the employee s SSN in the NM1 09 loop of the 837 file and the provider number from Provider 2 in the 2420A REF 02 loop. Provider 1/SSN: This option will put the value from the employee s Provider 1 in the 2420A NM1 09 loop of the 837 file and the employee s SSN in the 2420A REF 02 loop. Provider 2/SSN: This option will put the value from the employee s Provider 2 in the 2420A NM1 09 loop of the 837 file and the employee s SSN in the 2420A REF 02 loop. The employee s Provider ID 1 (the employee s Medicaid or National Provider Identifier) and Provider ID 2 (the employee s secondary Medicaid or National Provider Identifier) are found on the Other 2 tab of either the Employees or Employees (HR Only) dialog box. Refer to the Human Resources Module User s Guide for additional information on the Other 2 tab. If you want to create one claim per day in the 837 file for this bill code. For example, if the client received this service every day from 12/1 to 12/31, 31 claims would be included in the file. If you want to create a claim per day for every bill code for this funding source, select Single Claim Per Day check box on the 837 tab instead.. 27

28 Funding Sources. One Step Rate Adjustment Bill Limit Consumer Ratio HCPCS Type or select: If you need to create an adjustment for this bill code and you want to create the reversal of the original bill and the new bill in one step. If you use the one-step rate adjustment for every bill code for this funding source, select One Step Rate Adjustment check box on the 837 tab instead. NOTE: When you have the One Step Rate Adjustment turned on and need to truly give back units/dollars to a funding source, do NOT turn off the one step rate adjustment to create the negative. Instead, go into the contract and mark it replaced. This will allow you to create the negative (zero) bill to send to the funding source. Remember to change contract back to active after you create the negative bill. Keep in mind that this will reduce your revenue by the full dollar amount of the negative bill. If you then correct your transaction/contract to have a new dollar amount, but have not created the bill, the unbilled accrual will only capture the difference between the original bill and the new bill. You will need to make a manual journal entry for the original amount billed so your unbilled revenue is correct. We recommend that you use a reversing entry. For example, if you billed and were paid $235 for a day and create a negative bill, your revenue will be reduced by $235. If you create a transaction with a new rate of $250 (or change the rate in the contract), when you create the unbilled revenue for that day, it will only show the difference of $15. You will then need to record a manual journal entry (reversing) for the $235 until you actually create the new bill so your revenue will account for the full $250 ($235 original billed amount plus $15 increase). Bill To Limit Rollover - To bill to the regular limit and then bill any reserve if available. This is the option you should select if the Billing Category is Regular and you also have a corresponding bill code with a Billing Category of Reserve. Bill To Limit No Rollover - To bill to the regular limit only and no reserve applies and you want to perform limit checking. This is the option you should select if the Billing Category is Reserve. Bill All Units Served - To bill everything regardless of the limits set. Number of clients served together at the same time for this billing code. The Health Care Common Procedure Coding System (HCPCS) code that must appear on the 837 electronic file format for this funding source (if required). Use a colon to separate modifiers. You can have up to three modifiers in the code, for example, T2020:U1:U2. 28

29 Funding Sources ID 1 Facility Type Code Staff Ratio Rendering Provider ID Create 837 Order Type or select: Any additional identifier that needs to appear on the bills as required by the funding source. If you want the system to create new claims if the provider on prior authorization number changes within bill dates, you need to enter <SPECIALCLAIM2> as the ID 1. The facility type s code where this service type/bill code is provided to the client for use in the 837 electronic file format. You must enter a value in order for the correct claim status type to come out. The number of employees working with clients for this billing code at the same time. If the Include Service Line Rendering Provider check box is selected, select the provider ID of the employee (found on the Other 2 tab of the Employee dialog box) that you want to include in the electronic billing format: Provider ID 1 or Provider ID 2. If you want to specify the order the billing codes appear in the electronic file, assign a numeric order to each bill code as appropriate. If you leave them all set to zero (0), then they service will appear in the electronic file in the order of the claims created. *This field is required. Note If you are billing the Ohio Department of Mental Retardation/Developmental Disabilities (ODMR/DD), you will use the Ohio Billing Code Wizard to set up the bill codes for the majority of your services types. For details, refer to Bulletin KB90026 Configuring the Client Billing Module for Changes in the Ohio Billing Methodology available on the Solana Support Website or Chapter 10 of the Client Billing User s Guide.. 29

30 Funding Sources. 12. If you have selected the Use Global Rate check box and/or Use Global Limit check box, click New to add a global bill rate/limit. You will see the Billing Codes Global dialog box: 13. Type or enter the following information as required. Date Range* Type or select: The begin and end date of the range for which the rate and/or limit is in effect. Billing Rate Limit Type Limit The amount of the billing rate. None - No limits Day - A daily limit Week - A weekly limit Month - A monthly limit Contract Span - A limit for the date range specified The limit 30

31 Funding Sources Expected Limit Type or select: If negotiating a new limit with the funding source, enter the expected new limit. You can then run various reports based on the expected limit. *This field is required. 14. When finished, click Save. 15. Repeat steps Step 12 below through Step 14 below for each global billing rate/limit you want to add. 16. Click Save from the Billing Codes dialog box. 17. Repeat Step 9 below through Step 15 below for each service type. 18. Click the Rejection Codes tab. Rejection codes are a way that you can track the reasons why a bill was rejected by the funding source. Check with your funding source to see if they have a list of rejection codes and descriptions. You will use these codes when processing rejections for this funding source. You must have at least one rejection code set up in order to post rejections from the funding source. 19. Click New. You will see the Rejection Codes dialog box:. 31

32 Funding Sources. 20. Type or enter the following information as required. Type or select: Code* A unique, alphanumeric code for the rejection code. Description* A meaningful description of the rejection code. *This field is required. 21. Click Save. 22. Repeat Step 19 below through Step 21 below for each rejection code you need to add. 23. Click the GL Integration tab. The GL Integration tab is where you go to set up the accounts and descriptions that are posted to the General Ledger for this funding source during the billing and reconciliation process. You will see: 32

33 Funding Sources 24. Type or enter the following information as required. Bill Reference Number Type or select: The reference number that will appear in journal entries for bills for this funding source. Reconcile Reference Number Process Reject Reference Number Default Balance Sheet Account Default Income Statement Account Patient Liability Account Contract Adjustment Account Divide Units by Transaction Consumer Ratio The reference number that will appear in money transactions and journal entries for reconciliations for this funding source. The reference number that will appear in journal entries for process rejections for this funding source. The default balance sheet (accounts receivable) account code for this funding source. If you have already entered a default balance sheet account in the service type, it will supersede the one entered here. If you enter a default account, the software will automatically fill it in during contract detail entry. You can then override it at the contract detail level, if needed. The default income statement (revenue) account code for this funding source. If you have already entered a default income statement account in the service type, it will supersede the one entered here. If you enter a default account, the software will automatically fill it in during contract detail entry. You can then override it at the contract detail level, if needed. If using auto patient liability, the account number for the special patient liability account. This should be an asset account with the subaccount of Client Billing Clients assigned to it. The account number for the billing adjustment account. Any amount entered in the Adjustment box in the Reconciliations dialog box to account for any discrepancies from what was billed to what was actually received from the funding source is posted to this account. The account number set here will override the account number set up on the G/L tab of the Options dialog box. Note This is just a temporary holding account. The discrepancies posted here will need to be addressed usually through a journal entry that reclassifies it to the proper account such as revenue. To divide the number of units entered in the transaction by the consumer ratio entered in the transaction for billing purposes, if the Ratio Handling box on the Info tab is set to New Method.. 33

34 Funding Sources. Divide Rate by Bill Code Consumer Ratio Divide Units by Transaction Staff Ratio Divide Rate by Bill Code Staff Ratio Consumer: Find Bill Code Staff: Find Bill Code Use Bill Rate For UCR Type or select: To divide the rate entered in the contract by the consumer ratio entered in the bill code for billing purposes, if the Ratio Handling box on the Info tab is set to New Method. To divide the number of units entered in the transaction by the staff ratio entered in the transaction for billing purposes, if the Ratio Handling box on the Info tab is set to New Method. To divide the rate entered in the contract by the staff ratio entered in the bill code for billing purposes, if the Ratio Handling box on the Info tab is set to New Method. Always Use One - Always use the client ratio of one for the client when determining which bill code to use. Use Transaction Ratio - Always use the client ratio entered in the transaction for the client when determining which bill code to use. Use One If Ratio Is One; Otherwise 2 - If the client ratio is X:1 use the billing code for 1:1. If the client ratio is anything other than X:1, use the X:2 billing code. Always Use One - Always use a staff ratio of one for the staff when determining which bill code to use. Use Transaction Ratio - Always use the staff ratio entered in the transaction for the staff when determining which bill code to use. Use One If Ratio Is One; Otherwise 2 - If the staff ratio is 1:X use the billing code for 1:1. If the staff ratio is anything other than 1:X, use the 2:X billing code. Ohio Only: If this is the ODMR/DD funding source and you want to use the statewide reimbursement rate as your usual customary rate (UCR), select this box. For more information, see Bulletin KB90026 Configuring the Client Billing Module for Changes in the Ohio Billing Methodology available on the Solana Support Website. Note The HCFA 1500 tab is for legacy purposes only and is no longer used. 25. Click the File Info tab. If you are submitting your billings to the funding source electronically, complete the information on the File Info tab. 34

35 Funding Sources You will see: 26. Type or enter the following information as required. Electronic Counter Type or select: The starting number that is appended to the end of the file name. This number will automatically increment each time a bill is created for this funding source. It will start from 001 and go to 999, then it will move to A01 and go to A99, next it will move to B01 and go to B99 and so on through Z01 to Z99. Electronic File Name ID 1 - ID 4 Print Outstanding Bills Report Print Previous Detail The directory and file name where you want to save the electronic billing files. Up to four additional identifiers as needed to appear on the billings for this funding source. To automatically generate the Outstanding Bills report after posting a reconciliation for this funding source. To automatically generate the Previous Billing Detail Listing after posting a reconciliation for this funding source.. 35

36 Funding Sources. Print Previous Reconciliations Header Use Auto Patient Liability Type or select: To automatically generate the Previous Reconciliations Header Listing after posting a reconciliation for this funding source. To apply patient liability to billings for this funding source using the Patient Liability utility. If you have selected the Use Auto Patient Liability check box on the G/L tab of the Options dialog box, patient liability will be applied to all funding sources, regardless of this setting. 27. Click the 837 tab. If your funding source requires the use of the 837 file format for billing, you need to complete the information on the 837 tab and then complete the information on either the 837P or 837I tab (depending on the funding source s requirements). This information will be combined with the information set up on the corresponding tabs of the client s record. You will see: 36

37 Funding Sources 28. Type or enter the following information as required. Default Provider Type or select: The default provider for this funding source, if it is not indicated in the client s contract detail. Force 837 Files to Upper Case To write all data to upper case in the electronic file if required by the funding source. No New Lines on 837 Files Skip Claim Level Prior Auth Single Claim Per Client To create the electronic file without any carriage returns/line breaks. To prevent the prior authorization code from being included at the claim level in the electronic file output. To create one summary claim for each client. Otherwise, it will create one claim for each client/bill code/month/year. Use Bill Header ID for BHT03 To use Bill Header ID as the unique BHT03 in in the electronic file. Use Client Active/Inactive Date for Claims Set Claim Covered Days Show Without Decimal Single Claim Per Day To use the clients active date at the claim level and at the service level (if set to summarize): If the client's active date is after the bill header's begin date, then it will use the client's active date (instead of the bill header's begin date). If the client's inactive date is before the bill header's end date, then it will use the client's inactive date (instead of the bill header's end date). To calculate the number of days covered for selected billing date range. If Set Claim Covered Days is selected, select this check box to calculate the number of days covered for selected billing date range without decimal place. If there are ten covered days it will display as 10. If you want to create one claim per day in the 837 file for this funding source. For example, if the client received this service every day from 12/1 to 12/31, 31 claims would be included in the file. If you want to create a claim per day for specific bill codes, select Single Claim Per Day check box for the bill code instead. If you have selected Summarize on 837 Claims for any bill code, you must select this option at the bill code instead of at the funding source, because you cannot have summarize on 837 claims and single claim per day turned on for the same service.. 37

38 Funding Sources. One Step Rate Adjustment Facility Code Claim Code New Type or select: If you need to create an adjustment for this funding source and you want to create the reversal of the original bill and the new bill in one step. If you want to one step rate adjustments for particular bill codes, select Single Claim Per Day check box for the bill code(s) instead. If you have selected Summarize on 837 Claims for any bill code, you must select this option at the bill code instead of at the funding source. NOTE: When you have the One Step Rate Adjustment turned on and need to truly give back units/dollars to a funding source, do NOT turn off the one step rate adjustment to create the negative. Instead, go into the contract and mark it replaced. This will allow you to create the negative (zero) bill to send to the funding source. Remember to change contract back to active after you create the negative bill. Keep in mind that this will reduce your revenue by the full dollar amount of the negative bill. If you then correct your transaction/contract to have a new dollar amount, but have not created the bill, the unbilled accrual will only capture the difference between the original bill and the new bill. You will need to make a manual journal entry for the original amount billed so your unbilled revenue is correct. We recommend that you use a reversing entry. For example, if you billed and were paid $235 for a day and create a negative bill, your revenue will be reduced by $235. If you create a transaction with a new rate of $250 (or change the rate in the contract), when you create the unbilled revenue for that day, it will only show the difference of $15. You will then need to record a manual journal entry (reversing) for the $235 until you actually create the new bill so your revenue will account for the full $250 ($235 original billed amount plus $15 increase). Refer to the 837 Companion Guide provided by your funding source for details on these codes. Claim Code Reversal Claim Code Replacement 38

39 Funding Sources 29. Click either the 837P tab or 837I tab. 30. Click New. You will see the 837 Value dialog box.. 39

40 Funding Sources. 31. Type or select the following information as required. Type or select: Loop* , A, B, A, B, AA, AB, BA, BB, BC, BD, , , , A, B, C, D, E, , 8, A, B, C, D, E, F, G, H, , , A, B, C, D, E, F, G, , , X12-Header, X12 Trailer Refer to the 837 Companion Guide available from your funding source for details. Position* Refer to the 837 Companion Guide available from your funding source for details. Segment* Element* Value Funding Source This field is not used when setting up the 837 on the funding source side. Service Type If this entry is for a specific service type for this funding source, enter the service type code or press F2 to browse for it. If you leave it blank this entry will be created for all service types for this funding source. * This field is required. 32. Click Save. 33. Repeat Step 30 below through Step 32 below for each loop required for the electronic file. 34. Click Save from the Funding Sources dialog box and Close to exit. Exercise 2: Funding Sources Print a listing your funding sources for your records. 40

41 I/S Account Codes Lesson 4: I/S Account Codes Income statement account codes are assigned to the detail lines in the client s contract. The income statement account along with the cost center determines the revenue account/cost center combination to which the item should be posted. You can also set up a default income statement account code in the funding source or service type to save data entry time. To add an income statement account code: 1. On the Module menu, point to Client Billing, and then point to Setup and click I/S Account Codes. 2. Click Add from the Income Statement Accounts dialog box. 3. Enter or select the information below as required. Enter or select: Description* A description of the income statement account code. Revenue Code Write Off Code The natural or main revenue account number. This number is used with the account prefix and suffix set up in the cost center to make up a valid GL account number (if your GL account structure requires them). The natural or main write-off account number. This number is used with the account prefix and suffix set up in the cost center to make up a valid GL account number (if your GL account structure requires them). * This field is required. 4. Click Save. 5. Click Close to exit the window. Exercise 3: I/S Account Codes Print a listing of your I/S account codes for your records.. 41

42 B/S Account Codes. Lesson 5: B/S Account Codes Balance sheet account codes are assigned to the detail lines in the client s contract. The balance sheet account is tied to a receivables account that is set up in the General Ledger Module chart of accounts and is used for posting to the General Ledger. You can also set up a default balance sheet account code in the funding source or service type saving data entry time. Before you can add a balance sheet account code, you may need to set up these accounts in the General Ledger Module. Refer to the General Ledger Module User s Guide for details. Receivable Accounts Accrual Accounts To add a balance sheet account code: 1. On the Module menu, point to Client Billing, and then point to Setup and click B/S Account Codes. 2. Click Add from the Balance Sheet Accounts dialog box. 3. Enter or select the information below as required. Enter or select: Description* A description of the balance sheet account code. Receivable Account Accrual The account number of the receivable account or press F2 to find it. The account number of the accrual account or press F2 to find it. * This field is required. 4. Click Save. 5. Click Close to exit the window. Exercise 4: B/S Account Codes Print a listing of your B/S account codes for your records. 42

43 CL Cost Centers Lesson 6: CL Cost Centers Cost centers are used in conjunction with the income statement account code to determine which General Ledger Module accounts and cost centers to use for billing and payroll transactions. For example, you may have a cost center for each client or in a residence environment you may have a cost center for each group home. You are then able to capture the revenue by client or group home for reporting purposes in the General Ledger. Each cost center also includes the filters for Groups 1-3 that are used in reports and listings. Before you can add a cost center, you may need to set up these items: Groups 1, 2 and 3 General Ledger Costs Centers (See the General Ledger Module User s Guide) Payroll Cost Centers (See the Payroll Module User s Guide) Job Titles (See the Payroll Module User s Guide) To add a cost center: 1. On the Module menu, point to Client Billing, and then point to Setup and click Cost Centers. 2. Click Add from the Cost Centers dialog box.. 43

44 CL Cost Centers. 3. Type or select the following information from the Cost Center tab as required: Code* Type or select: A unique, alphanumeric code for the cost center. This code will be entered in Lookup boxes throughout the Client Billing Module. Description* Active GL Prefix GL Suffix Group 1* Group 2* Group 3* PR Cost Center Job Title GL Cost Center A meaningful description of the cost center. If the cost center is an active cost center in the system. The first part of the account number for the cost center. This number along with the code set up in the income statement code and the account suffix below must equal a valid General Ledger account number, if the General Ledger account structure requires a prefix/suffix. The last part of the account number for the cost center. This number along with the code set up in the income statement code and the account prefix above must equal a valid General Ledger account number, if the General Ledger account structure requires a prefix/suffix. The appropriate category from each of the group list boxes. These groups are custom lists that you can use to group cost centers together (for example, by program) for reporting purposes. The corresponding Payroll Module cost center s code (if you are merging transactions to the Payroll Module) or press F2 to browse for it. The job title s code or press F2 to browse for it, if you want the job title to be determined by the cost center. You must also select Use Job Title From Site from the Job Title list box on the Payroll tab of the Options dialog box. The corresponding General Ledger Module cost center s code (if you are using the General Ledger Module) or press F2 to browse for it. * This field is required. 44

45 CL Cost Centers 4. Click the Location tab. 5. Type or select the following information as needed. In tis field: Type or select: Name The name of the cost center. Address 1 and Address 2 City, State, Zip ID 1, ID 2, ID 3 The address where the cost center is located. The city, state and zip code of the cost center. Up to three other additional identifiers as needed for this cost center, for informational purposes. Ohio Only: Enter the identifier for a site as provided by ODMRDD in the ID 1 box. This is the identifier that will be used when running the ODMRDD Services Report. 6. When finished, click Save. 7. Click Close to exit the window. Exercise 5: Cost Centers Print a listing of your cost centers for your records.. 45

46 Options. Lesson 7: Options To set up the various options for the Client Billing Module: 1. On the Module menu, point to Client Billing, then point to Setup and click Options. 2. Click Edit. 3. Enter or select the information below as needed on the General tab. Enter or select: Aging Days 1-5 Up to five different aging days to show in the aging report. Group Descriptions 1-3 Print Outstanding Bills Report After Posting Reconciliation Use Transaction Wrapper A description for each of the three groups used for reporting purposes. To open the Outstanding Bills Report automatically after posting a reconciliation. This is a legacy field that is no longer used. 46

47 Options 4. Click the Payroll tab. The Payroll tab is where you will enter information related to integration with the Payroll Module. 5. Type or select the information below as needed. Begin Entry Date Type or select: If the Enforce Payroll Dates check box is selected, enter the first day of the current pay period. You will then need to modify this date for each pay period. End Entry Date Last Payroll Date Pay Rate Decimals Payroll Frequency Process Type If the Enforce Payroll Dates check box is selected, enter the last day of the current pay period. You will then need to modify this date for each pay period. The last pay day. This only needs to be entered at initial setup of the Client Billing Module. Once setup, the Last Payroll Date will automatically increment every time a new payroll is completed. The number of decimal places (up to three) that you would like to round for the pay rate. The standard rounding used by most employers is between two to three decimals. The frequency in which employees are paid: Weekly, Biweekly, Semimonthly, Monthly Regular - To merge the time transactions to the Hours/Amount Entry dialog box. By Day - To merge the time transactions to the Hours/Amount Entry By Day dialog box.. 47

48 Options. Hours Before OT Type or select: The number of worked hours before the hours are considered overtime. For example, if you pay your employees overtime for any hours in excess of 40 hours per week, enter 40 in this box. Employers who are using weighted overtime, should enter the largest number possible in this box (999). The software then will calculate the overtime in the Payroll Module instead of the Client Billing Module. This is the method that Solana recommends for calculating overtime. Count Holiday Worked Hours for OT If you are merging to payroll and you want to include holiday worked towards the number of hours worked before overtime is paid. The hours are considered holiday worked if they fall in the defined holiday schedule or if the hours are forced as holiday worked using the Force Wage Type box during time transaction entry. Enforce Payroll Dates Job Title Type To receive a warning message if a time transaction is entered that is outside of the dates entered in the Begin Entry Date and End Entry Date boxes. For example, if your pay period begins 02/13/06 and ends 02/26/06 and an entry has been entered for 02/11/06 (most likely caused by a late time sheet), you will receive a warning message. You will still be allowed to process the transaction if desired. The appropriate job title that an employee s time is to be charged to. Use Job Title From Site Use the job title set up at the site (Client Billing Cost Center) level and charge time transactions from the Client Billing Module to that job title. Use Default Job Title From Employee Use the job title marked as Primary (default) in the employee s record and charge time transactions from the Client Billing Module to that job title. Use Job Title From Service Type Use the job title set up in the service type that was selected for the time transaction and charge time transactions from the Client Billing Module to that job title. Use CL Job Title From Employee Use the user-defined job titles selected on the Job Titles tab of the Options dialog box and charge time transactions from the Client Billing Module to the job title in the employee s record that meets the criteria. If an employee has more than one matching job title, the software will use the first one. 48

49 Options Cost Center Type Use Weighted OT Calculations Calculate Weighted OT Weekly Restrict Modification of Payroll Processed Transactions Allow Indirect Service Types to a Client Type or select: The appropriate cost center to charge the employee s time transactions to. Use From Client Setup - Use the cost center set up at the site (Client Billing Cost Center) level and charge time transactions from the Client Billing Module to that cost center. If the client has departments set up, the software will use the cost center set there. Otherwise it will use the client s default cost center. Use From Service Type Use the cost center set up in the service type that was selected for the time transaction and charge time transactions from the Client Billing Module to that cost center. Direct From Client Indirect From Employee Use the cost center set up at the client level for any direct time worked and use the default cost center set up in the employee s file for any indirect time. If you are merging to payroll and you want to calculate weighted overtime calculations within the Client Billing Module. This option assumes that ALL time transactions and amounts for ALL employees are entered within the Client Billing Module.! Solana DOES NOT recommend the use of this option. It is our position that the calculation of overtime should occur in the Payroll Module. If you are merging to payroll and you want to calculate weighted overtime weekly within the Client Billing Module. This option assumes that ALL time transactions and amounts for ALL employees are entered within the Client Billing Module.! Solana DOES NOT recommend the use of this option. It is our position that the calculation of overtime should occur in the Payroll Module. To lock-down time transactions that have already been merged (payroll processed) to the Payroll Module. The important thing to remember before selecting this box is that if a time transaction is incorrect, you will not be able to modify it to correct for billing purposes. Instead you will need to enter an additional negative or positive time transaction depending on what needs to be corrected. If you want to allow indirect services types to be selected for a client during time transaction entry. This will charge the indirect time to the client s default cost center.. 49

50 Options. 6. Click the Job Titles tab. The Job Titles tab is where you will select the job titles to use in conjunction with the Use CL Job Title From Employee option in the Job Title Type list box on the Payroll tab. 7. Select the job titles you want to include/exclude: If you want to: Add one job title Then: Highlight the job title in the Not Member Of column and click Add One. Add multiple job titles Add all the job titles Remove one job title Remove multiple job titles Remove all the job titles Press CTRL while highlighting one or more job titles in the Not Member Of column, and then click Add One. Click Add All. Highlight the job title in the Member Of column and click Remove One. Press CTRL while highlighting one or more job titles in the Member Of column, and then click Remove One. Click Remove All. 50

51 Options 8. Click the G/L tab. The G/L tab is where you will enter information related to integration with the General Ledger Module. 9. Type or select the information below as needed. Contract Adjustment Account Type or select: The account number of the contract adjustment account or press F2 to browse for it. Any amount entered in the Adjustment box in the Reconciliations dialog box to account for any discrepancies from what was billed to what was actually received from the funding source is posted to this account. The account number set here is overridden if an account number is also set up on the GL Integration tab of the Funding Source dialog box. Receivables Account Post Level Detail - When the bill is committed, a detail line will be created within the General Ledger journal entry for each day for every client for every bill code. Client - When the bill is committed, a summary line will be created within the General Ledger journal entry summarized for every client for every AR control account. This is the typical setting. Account - When the bill is committed, a summary line will be created within the General Ledger journal entry for each GL account that makes up the entry.. 51

52 Options. Revenue Account Post Level Billing: Only Include Transactions with a contract Special Patient Liability Account Use Auto Patient Liability Calculate Ratio Increment Type or select: Detail - When the bill is committed, a detail line will be created within the General Ledger journal entry for each day for every client for every bill code. Client - When the bill is committed, a summary line will be created within the General Ledger journal entry summarized for every client for every income statement code (revenue) and cost center combination. This is the typical setting. Account - When the bill is committed, a summary line will be created within the General Ledger journal entry for each GL account that makes up the entry. To exclude errors for any item that there is not a contract for from error reports. Instead, run the missing contract report to view this type of error. The account number for the patient liability account or press F2 to browse for it. To use the Patient Liability utility to apply patient liability to the billings of all funding sources. You can also turn Auto Patient Liability on at the individual funding source level instead. If you are using the Calculate Client Billing Ratio Add-In select the increment that you want to software to use when calculating the ratios: One Minute Increment Five Minute Increment Ten Minute Increment Fifteen Minute Increment If the time transactions entered are not in the selected increment, you will receive an error message when you run the add-in. For example, if you select Fifteen Minute Increment, all time transactions entered would have to have time entered with one of the following minute designations 00, 15, 30 or 45 (for example, 4:00, 4:15, 4:30 or 4:45). 52

53 Options 10. Click the Data Entry tab. The Data Entry tab is where you will select options related to entering time, per diem and unit transactions. 11. Type or select the information below as needed. Repeat Service Type in Data Entry Require Department Check Per Diem Entry for Check Unit Entry for Type or select: To use the last service type selected for the next transaction entered after saving during data entry. To require a department to be entered during time transaction entry. When saving a per diem entry to check for: Duplicates - Two or more entries with the same date, client and service type. When saving a unit entry to check for: Duplicates - Two or more entries with the same date, employee, client, service type, staff ratio, consumer ratio and units. Consumer Ratio - The number of entries for the same employee, date, service type and units that do not equal the consumer ratio value. Staff Ratio - The number of entries for the same client, date, service type and units that do not equal the staff ratio value.. 53

54 Options. Check Time Entry for Per Diem: Show Place of Service Units: Show Place of Service Time: Show Place of Service Per Diem: Require Place of Service Units: Require Place of Service Time: Require Place of Service Per Diem: Show Bill Rate Units: Show Bill Rate Type or select: When saving a time entry to check for: Duplicates - Two or more entries with the same date, employee, client, service type, staff ratio, consumer ratio, begin time, end time and hours. Consumer Ratio - The number of entries for the same employee, date, service type, begin time, end time, and hours does not equal consumer ratio value. Consumer Overlap -For clients with a Type equal to Client on the Other tab of the Clients dialog box, the number of entries for the same client, date, begin/end time range does not equal the staff ratio value. For clients with a Type NOT equal to Client on the Other tab of the Clients dialog box, the number of entries for the same client, employee, date, begin/end time range does not equal the staff ratio value. Excess 24 Hours - The number of hours served divided by the staff ratio added up for one day for one client exceeds 24 hours. Entry After Midnight - Begin time is in one day and end time is in a later day. Staff Ratio - The number of entries for the same client, date, service type, begin time, end time, and hours does not equal staff ratio value. Staff Overlap - The number of entries for the same employee, date, begin/end time range does not equal the consumer ratio value. To show the Place of Service box during per diem entry. To show the Place of Service box during unit entry. To show the Place of Service box during time entry. To require the Place of Service box to be completed during per diem entry. To require the Place of Service box to be completed during unit entry. To require the Place of Service to be completed during time entry. To show the Bill Rate box during per diem entry. To show the Bill Rate box during unit transaction entry. 54

55 Options 12. Click the Contracts tab. The Contracts tab is where you will set up options related to the clients contracts. 13. Type or select the information below as needed. Contract Enforce Frequency Dates Type or select: If the Contract Limit Type is set to Week, then when you enter a contract, the contract s Begin Date must be the first day of the week (as defined in the funding source setup) and the End Date must be the last day of the week (as defined in the funding source setup). If the Contract Limit Type is set to Month, then when you enter a contract, the contract s Begin Date must be the first day of a month and the End Date must be the last day of a month. Contract Allow Changes To allow the contract to be modified after it has been saved. If this box is not selected, the contract detail lines can still be replaced or made inactive. 14. Click the Formats tab. The Formats tab is where you will select the billing formats needed by your agency. You can also set up your own custom formats if the format you need is not listed. 55

56 Options. here. The formats selected here as well as the custom ones you create will be available for selection when you create the billing output file. 15. Select (or clear) the Active check box next to the format(s) you want to include (exclude). 16. Click the Report Sorting tab. The Report Sorting tab is where you will select the default sort order for Client Billing Module reports. 17. Highlight an item in the list and click the up and down arrows to move it in the position in the list as desired. The item at the top of the list will be the highest sort order and so on down the list. 56

57 Options 18. Click the Report Filters tab. The Report Filters tab is where you can set up to three additional filter tabs for your reports. 19. Type or select the information below as needed. Description (1-3) Type or select: The description of the filter that will appear on the filter tab in the reports dialog boxes. Field Name (1-3) SQL Statement (1-3) The name of the field you want to filter on. The associated SQL statement for the filter and click Save. For example: 20. Click the Calc Ratios tab.. 57

58 Options. The Calc Ratios tab is where you can select the service types you want to calculate ratios for if you are using the Calculate Client Billing Ratios Add-In. 21. Select the service types you want to include/exclude: If you want to: Add one service type Then: Highlight the service type in the Not Member Of column and click Add One. Add multiple service types Add all the service types Remove one service type Remove multiple service types Remove all the service types Press CTRL while highlighting one or more service types in the Not Member Of column, and then click Add One. Click Add All. Highlight the service type in the Member Of column and click Remove One. Press CTRL while highlighting one or more service types in the Member Of column, and then click Remove One. Click Remove All. 22. When finished click Save and then click Close to exit. 58

59 Groups 1-3 Lesson 8: Groups 1-3 You can have up to three groups of descriptor items that you can use to categorize your cost centers when running many of the client billing reports. For example, you could set up a group for programs and then create an item representing each program you offer. Set the name for each of the three groups on the General tab of the Options dialog box. The name you assign here will appear in parenthesis in the various Group dialog box title bars and on the filter tabs in the various report dialog boxes. Add items to each group through its corresponding Group dialog box. You need to add at least one item to each group even if you are not using the group. If you are not using the group, create an item called N/A. To add an item to a group: 1. On the Module menu, point to Client Billing, and then point to Setup and click Group 1, Group 2 or Group Click Add from the Group dialog box. The name of the group is set on the General tab of the Options dialog box. 3. Enter or select the information below as required. Enter or select: Code* A unique, alphanumeric code for the item in the group. Description* A description of the group item. This description will appear in group list boxes. * This field is required. 4. Click Save. 5. Click Close to exit the window. Exercise 6: Groups 1-3 Print a listing of each of your groups for your records.. 59

60 Counties. Lesson 9: Counties You can assign the county where the service is performed to the client s record or contract detail. To add a county: 1. On the Module menu, point to Client Billing, and then point to Setup and click Counties. 2. Click Add from the Counties dialog box. 3. Type or select the following information in the Counties tab as required: Type or select: Code* A unique, alphanumeric code for the county. This code will be entered in Lookup boxes throughout the Client Billing Module. Description* ID 1, ID 2 Billing/Limits A meaningful description of the county. Up to two additional county identifiers for informational purposes if needed. Bill To Limit Rollover - To bill to the regular limit and then bill any reserve if available. Bill To Limit No Rollover - To bill to the regular limit only. Bill All Units Served - To bill everything regardless of the limits set. 60

61 Counties Use Funding Source for Billing Limit Type or select: To use the limits set up in the funding source for this county. * This field is required. 4. Click New to enter county roll over, if applicable. You will see the County Rollover dialog box: 5. Type or select the following information as required: Type or select: Service Date* The date this service was provided by this county. Bill Limit* * This field is required. Bill To Limit Rollover - To bill to the regular limit and then bill any reserve if available. Bill To Limit No Rollover - To bill to the regular limit only. Bill All Units Served - To bill everything regardless of the limits set. 6. When finished, click Save from the County Rollover dialog box. 7. Repeat Step 4 below to Step 6 below for each county rollover. 8. When finished, click Save from the Counties dialog box. 9. Click Close to exit the window. Exercise 7: Counties Print a listing of your counties for your records.. 61

62 Places of Service. Lesson 10: Places of Service Places of service are sometimes required for those agencies using the 837 electronic file format to submit billings to their funding source. Check with your funding source for its electronic file format requirements. Tip You can make the Place of Service box appear on various data entry dialog boxes (Time Transactions, Unit Transactions and Per Diems), if the appropriate Show Place of Service check box is selected on the Data Entry tab of the Options dialog box. You can make it required, if you select the appropriate Require Place of Service check box as well. To add a place of service: 1. On the Module menu, point to Client Billing, and then point to Setup and click Place of Service. 2. Click Add from the Place of Service dialog box. 3. Type or select the following information in the Place of Service tab as required: Code* Type or select: A unique, alphanumeric code for the place of service. This code will be entered in Lookup boxes throughout the Client Billing Module. Description* Active A meaningful description of the place of service. If the place of service is an active place of service in the system. * This field is required. 4. When finished, click Save. 5. Click Close to exit the window. Exercise 8: Places of Service Print a listing of your places of service for your records. 62

63 Providers Lesson 11: Providers If your agency has multiple provider numbers and you are using the 837 electronic file format to submit billings to your funding source, you will need to set up a separate provider for each of your provider numbers. Check with your funding source for its electronic file format requirements. To add a provider: 1. On the Module menu, point to Client Billing, and then point to Setup and click Providers. 2. Click Add from the Providers dialog box. 3. Enter or select the information below as required. Enter or select: Description* A description of the provider. Organization Name* Identification Code* Address* City*/State*/Postal Code* Secondary ID Qualifier The organization name of the provider. The provider s identification code. The provider s street address. The provider s city, state and zip code. A secondary ID qualifier as indicated by your funding source for the 837 file.. 63

64 Providers. Enter or select: Secondary ID A secondary ID as indicated by your funding source for the 837 file. Identification Qualifier Use Provider Taxonomy Code Provider Code Provider Taxonomy Code 24 - If the Identification Code is the provider s Medicaid ID number (if you leave this field blank, it will default to 24) If the Identification Code is the provider s Social Security number XX - If the Identification Code is the provider s National Provider Identifier. If you have more than one taxonomy code per funding source. If using this feature, you will need to create your bill by service type to ensure the correct taxonomy code is in the file. The two-character provider code: BI (for billing) PT (for pay to) Your agency s taxonomy code (if the Use Provider Taxonomy Code check box is selected). * This field is required. 4. Click Save. 5. Click Close to exit the window. Exercise 9: Providers Print a listing of your providers for your records. 64

65 Billable Transaction Sets Lesson 12: Billable Transaction Sets Billable Transaction Sets allow you to map nonbillable service types with a type of worked time direct to a billable service type. When you run the Create Billable Transactions utility, it will create a per diem or time transactions for the billable service type selected based on the setup for those clients with the nonbillable service type listed and a matching billable transaction client type. If the Billable Transaction Client Type is blank on both the Other tab of the Clients dialog box and in the Billable Transaction Set dialog box, the utility will look across all client with the nonbillable service type transactions and create a billable service type transaction. To add a billable transaction set: 1. On the Module menu, point to Client Billing, and then point to Setup and click Billable Transaction Sets. 2. Click Add from the Billable Transaction Sets dialog box. You will see:. 65

66 Facility Type Codes. 3. Type or select the following information as required: Description* Type or select: A meaningful description of the billable transaction set. This description will appear in the Billable Transaction Set list box in the Create Billable Transaction utility. Billable Service Type Transaction Type Billable Transaction Client Type The service type code of the billable service type that you want the nonbillable service types selected below to create transactions for or press F2 to browse for it. The service type must have the Billable check box selected in the Service Type dialog box in order to select it for this field. Per Diem Transaction - to create a per diem for the billable service type. Time Transaction - to create a time transaction for the billable service type A code for the billable transaction set that you will assign to those clients that you want to create billable transactions. The code you enter here must match the code entered in the client. If you leave this field blank, the utility will create a billable transaction for all clients with the non-billable service type. * This field is required. 4. Include (or excluded) the non-billable service types as needed. The service types listed do not have the Billable check box selected in the Service Type dialog box. If you want to: Then: Include one service type Highlight it in the Not Member Of column and click Add One. Include multiple service types Include all service types Exclude one service type Exclude multiple service types Exclude all service types Press CTRL while highlighting one or more service types in the Not Member Of column, and then click Add One. Click Add All. Highlight it in the Member Of column and click Remove One. Press CTRL while highlighting one or more service types in the Member Of column, and then click Remove One. Click Remove All. 5. When finished, click Save and then click Close to exit the window. Lesson 13: Facility Type Codes Facility type codes are sometimes required for those agencies using the 837 electronic file format to submit billings to their funding source. The facility type code refers to the type of facility where the 66

67 Facility Type Codes services were performed. Check with your funding source for its electronic file format requirements. To add a facility type code: 1. On the Module menu, point to Client Billing, and then point to Setup and click Facility Type Codes. 2. Click Add from the Facility Type Codes dialog box. 3. Enter or select the information below as required. Enter or select: Description* A description of the facility type code. Code Value* The code value for the facility type as indicated by your funding source for the 837 file. * This field is required. 4. Click Save. 5. Click Close to exit the window. Exercise 10: Facility Type Codes Print a listing of your facility type codes for your records.. 67

68 UCRs. Lesson 14: UCRs Usual customary rates (UCRs) are used by the Ohio Department of Mental Retardation/Development Disabilities (ODMR/DD). Ohio agencies are required to include UCRs in their billing files to ODMR/DD. Ohio agencies can set up UCRs for the 14 roll-up bill codes and the medical and behavior add-ons at the company level. Ohio agencies will manage their company-level UCRs through the UCRs dialog box. Refer to Bulletin KB90026 Configuring the Client Billing Module for Changes in the Ohio Billing Methodology for details (found on the Solana Support Website under White Papers). In order to add UCRs, you must first set up: Counties To add a UCR: 1. On the Module menu, point to Client Billing, and then point to Setup and click UCRs. 2. Click Add from the UCRs dialog box. 68

69 UCRs You will see: 3. Enter or select the information below as required. Enter or select: County* The county of service s code or press F2 to browse for it. Rollup Code* Effective Date* UCR If UCR is for one of the 14 Ohio roll-up bill codes, then enter that code here, for example, A22, A44, etc. and enter your rate in the UCR box. If the UCR is for the behavior support add-on UCR, then enter BEHAVIOR and enter 0.63 in the UCR box. If the UCR is for the medical assistance add-on UCR, then enter MEDICAL and enter 0.12 in the UCR box. If the UCR is not for one of the above, then you will enter the UCR at the contract level. The date the rate for this county and rollup code combination goes into effect. The billing rate. * This field is required. 4. Click Save. 5. Click Close to exit the window.! Do not modify a UCR to update the rate and effective date. Doing so will cause previous billings to be incorrect. Instead add a new UCR when a new rate goes into effect and leave the old UCR in the system with the old effective date. Exercise 11: UCRs Print a listing of your UCRs for your records.. 69

70 Service Type Conversions. Lesson 15: Service Type Conversions Service Type Conversions allow you to set up the rules for converting billable service types to nonbillable service types in time transactions for a particular site. After you set up the rules, the Service Type Conversion utility converts the service types in the time transactions for the specified date range based on these rules. In order to add service type conversions, you must first set up: Service Types Cost Centers To add a service type conversion: 1. On the Module menu, point to Client Billing, and then point to Setup and click Service Type Conversions. 2. Click Add from the Service Type Conversions dialog box. 3. Enter or select the information below as required. Description* Cost Center* Enter or select: A meaningful and unique description of the service type conversion. The code of the cost center for any time transactions for which you want to convert service types or press F2 to browse for it. 70

71 Service Type Conversions Begin Date* Enter or select: The date this cost center will begin converting billable service types to non-billable service types * This field is required. 4. Click New to enter the service type rules. 5. Type or select the following information as required: To* Type or select: The code of the non-billable service type that you want to convert to or press F2 to browse for it. Tip If you are merging time transactions to the Payroll Module, make sure you set up the payroll-related information in the non-billable service type. From* The code of the billable service type that you want to convert from or press F2 to browse for it. * This field is required. 6. When finished, click Save. 7. Repeat Step 4 below to Step 6 below for each service type you want to convert for this cost center. 8. Click Save. 9. Click Close to exit the window. Exercise 12: Service Type Conversions Print a listing of your service type conversions for your records.. 71

72 Departments. Lesson 16: Departments If you are integrating with the Payroll Module, you can set up the departments that you want to allocate the payroll expenses to for clients. These departments can then be assigned to the client and then to the time transaction of the client the employee served thereby segregating the expense. You must also select either the Use From Client Setup or the Direct From Client Indirect From Emp option from the Cost Center Type list box on the Payroll tab of the Options dialog box. Departments are useful if you want to break out the client s payroll expenses to multiple cost centers Tip You can make the department required during data entry by selecting the Require Department check box on the Data Entry tab of the Options dialog box. To add a department: 1. On the Module menu, point to Client Billing, and then point to Setup and click Departments. 2. Click Add from the Departments dialog box. 3. Enter or select the information below as required. Enter or select: Code* A unique, alphanumeric code for the department. Description* A description of the department. * This field is required. 4. Click Save. 5. Click Close to exit the window. Exercise 13: Departments Print a listing of your departments for your records. 72

73 Holiday Times Lesson 17: Holiday Times You can set up your holiday schedule and then let the software determine the wage type code to use based on the wage type codes set up in the service type. To add holiday times: 1. On the Module menu, point to Client Billing, and then point to Setup and click Holiday Times. 2. Click Add from the Holiday Times dialog box. 3. Enter or select the information below as required. Enter or select: Description* A description of the holiday time (that includes the year). Begin Time End Time Holiday Code The date and time the holiday time begins. Enter 12:00 AM to indicate the beginning of a 24-hour period. The date and time the holiday time ends. Enter 11:59 PM to indicate the end of a 24-hour period. A, B or C (This code corresponds to the Hol A, Hol B, Hol C, Hol A OT, Hol B OT, Hol C OT tabs on the Service Types dialog box). * This field is required. 4. Click Save. 5. Click Close to exit the window. Exercise 14: Holiday Times Print a listing of your holiday times for your records.. 73

74 Premium Times. Lesson 18: Premium Times You can set up your premium time schedule and let the software select the appropriate wage type code during time transaction entry based on the wage types set up in the service type. To add premium time: 1. On the Module menu, point to Client Billing, and then point to Setup and click Premium Times. 2. Click Add from the Premium Times dialog box. 3. Enter or select the information below as required. Enter or select: Description* A description of the premium time. Premium Code Begin Day of Week Begin Time End Day of Week End Time A, B, C, D (This code corresponds to the premium boxes of the various tabs at the bottom of the Service Types dialog box). The day of the week the premium time begins. The time of day the premium time begins. Enter 12:00 AM to indicate the beginning of a 24-hour period. The day of the week the premium time ends. The time of day the premium time ends. Enter 11:59 PM to indicate the end of a 24-hour period. * This field is required. 4. Click Save. 5. Click Close to exit the window. 74

75 Custom Billing Formats Exercise 15: Premium Times Print a listing of your premium times for your records. Lesson 19: Custom Billing Formats If a standard billing format is not available on the Formats tab of the Options dialog box, you can create your own custom format. You will manage your custom billing formats through the Custom Billing Format dialog box. The custom formats you create will be available for selection when you create the billing output file. To add a custom billing format: 1. On the Module menu, point to Client Billing, and then point to Setup and click Custom Billing Formats. 2. Click Add from the Custom Billing Format dialog box. 3. Enter the following information as required: Description Enter or select: A text description of the layout. This description will appear in the Custom Billing Format lists throughout the module. Top Left Right Bottom Length A number in inches for the top page margin. A number in inches for the left page margin. A number in inches for the right page margin. A number in inches for the bottom page margin. A number in inches for the height or length of the page.. 75

76 Custom Billing Formats. Width Portrait Landscape Header* Detail* Footer* Type Page Break on Client Enter or select: A number in inches for the width of the page. If the billing format will print in portrait format. If the billing format will print in landscape format. A number in inches for the height of the header. A number in inches for the height of the detail. A number in inches for the height of the footer. Summary Detail Create a page break after each client so that each client s billing information starts on a new page. * One of these fields must be set to 0 to indicate the top of the page. 4. Click Format Layout. You will see the Custom Billing Format dialog box. 5. You can add data fields, custom data fields and lines to the header, body (detail) or footer of the billing format. You can only add graphics to the header or the footer of the billing format. 76