Billing Rates

Background

In HealtheFirst, billing rates are the driving force behind a number of actions.  In this article, we'll walk through those various settings and functions so that you can make the most of what HealtheFirst has to offer.  

Configuration

Billing rates can be accessed and edited from the Navigation Menu > Billing Rates.

Staff Description

This is the rate description that staff will see when completing a service, as well as in most searches and reports.  It is NOT, however, used for reimbursement billing, so it can be a user-friendly description.

Show on Client Service

When enabled, this rate should be an option for services that are assigned to a client.

Show on Non-Client Service

When enabled, this rate should be an option for services that are not assigned to a client.

Require Approval

When enabled, services with this rate will be eligible for the approval workflow.  Click here for additional information.

Input Combination

This determines which two field will be present in the service.  For the service to be considered "complete," both fields will need to be completed.

• Time + Time:  Users will need to enter a start date and time, and an end date and time.
• Date + Units:  Users will need to enter a start date, and a number of units.  (Units can refer to medical units of work, a number of hours, a number of miles, or any number of things)
• Date + Amount:  Users will need to enter a start date, and a dollar amount.
• Date + Visit:  Users will need to enter a start date, and checkmark indicating that the service is complete.

First Input Label

The input combination determined which two input field will be present on the service.  This is the label text that will be above the first input.

Second Input Label

The input combination determined which two input field will be present on the service.  This is the label text that will be above the second input.

Minute Per Unit

When set and the input combination is "Time + Time," users will still be entering a start and end time for the service, but the system will calculate the number of units of work based on the time entered.  The unit calculation can then be used for billing and payroll.  

When set and the input combination is "Date + Units," users will be entering a date and unit total for the service, but the system can calculate the duration of the service for reporting and evaluation.  Billing and payroll in this case will still be done on a unit basis.

Automatically Set "End" Date & Time

When enabled and the input combination is "Time + Time," the end time will default to 1 hour from the start time when the user sets the start of the appointment.  Users will be able to further adjust the time, but this can help eliminate redundant clicks for standard appointments.

Is Billed As Visit

When enabled, regardless of the inputs, services with this billing rate will be billed as a fixed fee amount (similar to "Date + Visit" rates).  This allows organizations to continue to track time or other information internally, while billing on a fixed fee for services.

Do you need to bill for services with this rate?

Group

This allows you to set different groups of billing rates.  This information will only be present on the Reimbursements and Invoices pages, where it will appear as a filter.  It may be helpful to use a different group for billing rates that differ from your standard billing process, so services can be isolated and filtered for on the billing pages.

Is Invoiced

When enabled, completed services with this billing rate will be found on the Invoices page and invoices can be generated for payment.  When disabled, completed services will be found on the Reimbursements page and will be ready for medical clearinghouse or other billing practices.

Combine Services

When enabled, services will be combined into a single "line item" for medical clearinghouse billing, which can be helpful for pre-enrollment or similar services.  This only applies to non-invoiced billing rates, and will not have an affect on invoices.

Billing Code

This contains the official billing code needed for medical clearinghouse billing, and will not have an effect on invoices.

Price

The amount to be billed.  The amount varies slightly based on the input combination:

• When "Time + Time" is selected, and minutes per unit is not set, you will be setting the amount per hour that should be billed.
• When "Time + Time" is selected, and minutes per unit is set, you will be setting the amount per "unit" that should be billed .
• When "Date+ Units " is selected, you will be setting the amount per unit that should be billed .
• When "Date  + Amount " is selected, you will be setting the % of the service amount that should be billed.
• When "Date  + Visit " is selected, you will be setting the amount that should be billed per completed service.

Currency

The currency with which to bill. 

Do you need to pay staff?

In this area, you will find a list of staff roles.  You can specify a different dollar amount to pay each staff member by role.  Setting this information is how dollar totals are calculated on the Payroll page.  The amount varies slightly based on the input combination.  Please see the following table for additional information.

• When "Time + Time" is selected, and minutes per unit is not set, you will be setting the amount per hour that should be paid.
• When "Time + Time" is selected, and minutes per unit is set, you will be setting the amount per "unit" that should be paid.
• When "Date+ Units " is selected, you will be setting the amount per unit that should be paid.
• When "Date  + Amount " is selected, you will be setting the % of the service amount that should be paid.
• When "Date  + Visit " is selected, you will be setting the amount that should be paid per completed service.

The amount paid can also be set from the role editor page, and can be overridden from a staff's profile.  If a payroll amount is set on the staff's profile, it will take precedent over the role-related amount.

Advanced Options

Default Billing Rates

The default billing rate can be explicitly set in a two ways, as outlined below.

By Client Case

Create or edit a client's case (Clients > [select client] > [select case]), and you will see a dropdown to select a default billing rate.  When set, any time a service is created and is associated with this client and this case, the selected billing rate will be the default option.  This setting has the highest precedence.

By Client Status

Edit a client status (Clients > Statuses > [select status]) and you will see an option to select a default billing rate.  When set, any time a service is created for a client with this status, the specified rate will be the default.  If the client's case has a default rate, though, it will take precedent.

Limit the Billing Rate Options

In the basic configuration, if you are viewing a service with a client, you will only see rates that are eligible for client services, and vice versa for non-client services.  However, there are two other ways to limit the rates that are displayed:

Configuration > Services > Only Show Tracking Billing Rates

When enabled, only billing rates that are being tracked for a client and case will appear as options for users to select.  If, however, no rates are being tracked, the default logic will fall back in place, and users will see all of the rates eligible for their client service.

Clients > Statuses > [select status] > Valid Billing Rates

The status associated with a client can also be used to select valid rates.  When rates are selected at this level, only those rates will be available in the service.

Hidden Billing Rate

This isn't so much a setting as a note, but anytime a service has only one billing rate option, the rate will be automatically selected, the input fields automatically set, and the billing rate dropdown will be hidden.  This can be due to their only being one non-client rate in the system for a non-client service, only one client rate for a client service, or can be due to the limiting list configurations noted above.

Only Bill a Percent of the Rate

There may be some cases where a client's service is assigned to a specific rate but they are being billed differently.  Whether they are eligible for a discount, a surcharge, or something else entirely, the system can accommodate.

1. Go to Configuration > Services and enable "Billing Percent by Case."
2. Go to Clients > [select client] and edit one of their cases.
3. In the case, you will now see an option to set a percent of the billing rate's amount to be billed.  For instance, if the billing rate is set to bill at $100/hr but, for this client and case, you want to be billing $95/hr, you can enter 95% and the system will make the appropriate calculations on the reimbursement or invoicing side of things.
4. Save.