Overview

This document is to provide steps for adding a single case rate in the system. Single case rates are assigned at the patient account level. 

1. Click Admissions
2. Select Admissions
3. Enter the patient Medical Record number then select Admission Portal.
   
4. Select Insurance under the Admission Info Section.
   
5. Click on Override Rate Schedule and then select the appropriate next action
   

Create New Case Rate - Just like creating a new rate schedule

Once the box populates fill in the following fields.

1. Code-Abbreviated Name of the Rate schedule
2. Description- Full Name of the Rate schedule
3. Contractual Adj Description- Example is C/A
4. Contractual Adj Trans Type- Unique for each client. Consult internal accounting team.
5. Write-off Description- Example is C/A
6. Write-off Trans Type- Unique for each client. Consult internal accounting team.
7. Adjustment Level- Claim is recommended, but the option to create the adjustment at the claim line or charge level is also available.

Once the user has filled in the above fields you must check which check boxes are needed for this SCA Rate.

Below are the meanings of the different check boxes

1. Bill at Net-this means the claims will bill at the net rate not the gross rate on the claims
2. Is All Inclusive- There are two different scenarios listed below. Please contact a system representative with questions.
   • If checked the services will net down and any service that is not added to the rate schedule will write off to zero
   • If it is not checked services will not take the contractual and will be that the gross rate if the service is not listed
3. Include Variable Rate Services- In the service master there is a checkbox that will allow a user to override the gross rate, thus it is variable. If the user is adding ANY variable rate service to the rate schedule, they must check this box or the system will NOT adjust/contractualize the rate. 
4. IS DRG- If the payor pays DRG it must be checked
5. Include Sequestration- only checked if DRG is checked
6. Write Off Lab- If lab charges need to be written off check this box
7. Write Off Pharmacy- If pharmacy charges need to be written off check this box
8. Write Off Therapy- If Therapy charges need to be written off check this box
9. Bill zero charges- check if the zero charges should be included on the claim
10. Click Save

Once the user has created a rate schedule then you can add the services by doing these steps

1. Choose the rate schedule you just created.
2. When the box in the bottom populates click Add Services. The services can be added one at a time or multiple. The instructions below are for adding multiple services. 
   • If another rate schedule exists with the same or similar net rates, then the option to copy is also available in the ribbon bar.

3. Begin to choose the services that you would like added just by click the box next to the service code. When you have chosen all the services needed Click Select

4. Once the user has selected the services that need to be added the user will have to set the net rate for the services. The net rate is what the system will contractualize the service down to on the claim. The gross rate is what will go out on the claim, but the net rate is expected reimbursement for that service.  To set the net rate follow these steps.

1. Highlight the service
2. Click Set Net Rate

3.  Fixed Net rate- Put the rate that you would like for the service(s) to adjust down to on the claim.

4. Click Save

The user should do this for all of the services that were selected. The user can add multiple services at a time if those services are going to have the same Fixed Net rate

Copy Standard Rate Schedule - Allows you to select a Payer Rate Schedule and pull existing services and rates. These services and rates can then be edited.

Copy Case Rate - Can copy from an existing case rate that exists on another patient account.

Use Standard Rate Schedule - Allows you to select a different Payer Rate Schedule but does not allow any changes to be made.