Ohio Medicaid Rate and Unit Change Instructions

Agencies will need Main Office Software version 5771 or higher.  Agencies should wait until they have entered all June Visits into the software before setting up new billing rates and units.  The software will determine visit amounts when the visit is entered into the software.  If July visits are entered prior to rate changes, billing utilities can be run to recalculate visit amounts.

In Service set up for each Ohio Medicaid RN, LPN, and Aide service, agencies will need to update the Insurance Company Rates tab.  Once the applicable insurance is selected in the grid, agencies will need to select and complete the Billing Tier rates tab to update the previously entered billing rates and units.  The field for Hours to Units Alternative calculation will need to display ‘Ohio Medicaid 15,34,45,60.  These Unit calculations will only be performed on visits dated 7/1/15 or later. The check box, ‘$Rates are fixed $ amounts/visit for highest level reached should be marked.  Tier rates should hold incremental billing rates/hour for the service.  Level One will be the rate for 0-15 minutes.  Level Two will be 16 minutes over and the appropriate billing rate.  Levels will be completed up to the 3rd.  New data entry fields on the right side of the screen will then need to be completed in the Higher Level Tier Incremental Rate section.  The ‘Additional Levels Minute Increments’ should hold a 15.  ‘Incremental Rate per Hour/Level for Increment’ field will hold the Level One rate for the service.  A 60 will need to be populated in the last field ‘For minutes over’.

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