- Adult Day and Vocational Habilitation services must be a client/staff ratio of 16:1 (or less).
- Adult Day and Vocational Habilitation with Community Integration must be a client/staff ratio of 4:1 (or less). Note: Community Integration services can only be billed "per unit" (no daily rates).
- Career Planning services must be a client/staff ratio of 1:1.
Locked Billing Data
Attendance data cannot be changed or deleted once the corresponding billing data has been locked. In order to change attendance data when it is necessary to re-submit billing data, the billing data must be unlocked before changing the attendance data.
Add-On's (Client Information)
- Force Custom Daily Rate. When this is checked (per client), the net billing rate will be equivalent to the custom daily rate, even when billing is "per unit". Custom codes and rates must be setup if this is used.
There are two methods that the daily rate is calculated. If the Partial custom code is NOT "NA", then the billing rate will be divided by the number of total units for the day (see Example 1). If the Partial custom code is "NA", then the billing rate will be equivalent to the Custom code rate, regardless of the number of total units for the day (see Example 2).
Notice the Partial Day Code is NOT "NA". If the total daily units is 10, then the billing rate would be 70/10 or $7.
Since the Partial Day Code is "NA", the billing rate will always be $70 no matter how many total units.
- Unit Rate Billing Only. When this is checked (per client), there will be an option in the daily attendance to force unit billing even when the total units would normally convert to a daily rate (20 - 28). This does not actually set the billing data to units, but allows the option to be accessed. Only when the 'Unit Rate Billing' checkbox on the Attendance screen is checked will the billing data be forced to units.
- Community Integration. When this is checked (per client), services with Community Integration are allowed. When this is unchecked, an error will occur if the client is added to a service with Community Integration.
IMPORTANT: the Group size must be no more than 4. With a group of more than 4, the group size is calculated by dividing the client count by the staff count.
- Behavior. When checked the Behavior Add-On can be used. This does not actually change billing data, but allows the option to use this Add-On. Only when the 'Use Add On' checkbox on the Attendance screen is checked will the billing data be affected. This will add an additional 63 cents per unit and force "per unit" billing.
- Medical. When checked the Medical Add-On can be used. This does not actually change billing data, but allows the option to use this Add-On. Only when the 'Use Add On' checkbox on the Attendance screen is checked will the billing data be affected. This will add an additional 12 cents per unit and force "per unit" billing.
- No Transport Limit. When this is checked (per client), the total number of transportation trips is not limited. Otherwise, the total number of transportation trips will be a maximum of 2.
- Skip HPC Transport Billing. When this is checked (per client), billing data for HPC transportation will not be automatically created.
- Billing Hold. When this is checked (per client), no billing data will be included in any invoices.
- Clermont County Contract. Special billing for clients under a Clermont County contract.
Exclude Billing from DODD/Medicaid
For clients that receive funding from sources other than DODD/Medicaid, 'Cost Centers' are used to setup a group of clients within a set of services that can be excluded from the DODD billing data. There may be times when a client is normally "excluded" from the DODD billing, but for only a certain period of time this exclusion is ignored and as such included in the DODD billing. To accomplish this, a span date (Client Information) can be setup and the option 'Ignore DODD Exclude' can be set. When this is set, the custom codes will also be ignored.
Using Daily Rate
The most fundamental rule for using a daily rate is having the accumulative units for one service code in one day total from 20 - 28 units. There are a few conditions that need to be met:
- The service must be one that allows the daily rate.
- The Behavior Add-On and Medical Add-On cannot be used.
- The 'Unit Rate Billing' option must be off. It's important to note that this option should only be used when a client's plan allows for it. Overriding the daily rate rule of 20-28 units may result in a billing error if the client is not setup to allow for this exception.
- There cannot be another service for the same client on the same day with a daily rate. So if there are multiple services that qualify for a daily rate on the same day, both of those services must be billed at a unit rate.
- For ADS and VocHab, the county of the Agency is usually what is used in the billing calculations. If the physical location of the DayHab program is in a different county, then the county as defined in the Program is used in the billing calculations.
- For Supported Employment, Career Planning, Transportation, and HPC, the county of the client is used in the billing calculations.
- A full day is greater than 15 units and billed at $64.94.
- A partial day is less than 15 units and billed at $32.48.
- Public Transportation rates are used when 1) a route is setup as "Public Transportation" in 'Setup-Transport Routes', or 2) a Vehicle is used on a route that is setup as a "Commercial" vehicle in 'Setup-Vehicles'.
- For multiple Public Transportation trips on the same day, the number of trips gets converted to 1 unit in the billing, and the rate for each trip is combined (all added together) as the billing rate.
- Per trip vs. per miles billing is determined by whether the Vehicle assigned to the route is setup as 'Per Trip' or not.
- If a route is "per miles" and mileage has not been entered, an error will displayed.
- A maximum of two trips per day is the standard. If the 'No Transport Limit' is set in 'Client Information', then there is no maximum limitation per day.
- A custom rate may be used on the Transport Scheduler screen which will take precedence over the standard rates.
Custom Codes and Rates per Client
- Custom codes and rates "per client" are set in Client Information.
- When these custom codes and rates are used, they take precedence over the standard codes and rates.
Although these are typically used for situations where the billing is non-DODD and included in a Cost Center, it doesn't necessarily have to be.
- IMPORTANT! When setting up custom codes for ADS or VocHab, all four custom codes must be setup. And each code must be different. The same codes cannot be used for ADS and VocHab. Here is an example:
Custom Codes and Rates for Multiple Cost Centers per Client
For those situations where a client has multiple funding sources for the same service in the same day, custom codes and rates can be setup in a separate billing table.
- Create Cost Centers for each of the funding sources that will be used.
- Add the client and services to the Cost Centers that will be used for each of the funding sources.
- Be sure there is not a Custom Code on the Client Information screen for the clients that will be using the multiple funding sources.
- Once the client has been added to the daily attendance / HPC timesheet, click on the client name and select the Cost Center/Funding Source.
- For HPC, if you add HPC Transportation, be sure to select and save the Cost Center AFTER the HPC Transportation has been added.
Force Daily Rate
On the Client Information screen in the 'Services and Add-Ons' section, there is an option for 'Force Daily Rate'. When this is checked, the rate will be set to the daily rate no matter how many units are used for that day.
Manually Setting Daily Rate
There are two conditions that will cause a 'Daily Rate' button to appear on the billing screen when a billing record is selected:
- When the total number of units for either ADS or VocHab is between 20 and 28.
- When the total number of units combined for ADS and VocHab is between 20 and 28.
When the 'Daily Rate' button is clicked, the selected billing record will be converted to a daily rate.
Note: Be sure that the client's plan allows for daily rates with these conditions.
Billing Options Per Client for Attendance
When entering attendance information, there are three billing options on a "per client" basis that could be in play based on the setup of the client. Each of these options, if applicable, will be displayed in the form of a checkbox when clicking on a client:
- Unit Rate Billing. If a client is setup with 'Unit Rate Billing Only' (set on the Client Information screen), then choosing this option will force the billing to be a "Unit" rate, even if the number of units qualifies for a daily rate.
- Use Add-On. If a client is setup with either a 'Medical' or 'Behavior' add-on (set on the Client Information screen), then choosing this option will add the appropriate add-on amount to the billing.
- Medicaid Billing. When a client has a custom code setup for ADS or VocHab, the option will be available. If this option is NOT checked, then the custom code and rate will be used in the billing. By checking this option, the standard Medicaid billing code and rate will be used instead of the custom code and rate.
Billing county boards is done using a Cost Center with "Exclude from DODD". The billing data in the County Board Cost Center will not be included in the standard Medicaid waiver invoice flat file. To create the County Board flat file, select the corresponding Cost Center on the billing screen:
Click the 'Invoice' button and a flat file for the selected Cost Center will be created.
NOTE: if the Medicaid number for a client is blank, then the Social Security number will be used in its place.