Allegheny Messages

Available with Main Office software version 5795 dated 8/5/15 an additional field has been added to Services, Insurance Company Rates, Rates tab for agencies invoicing Ohio Medicaid.  Agencies in Ohio who report on claims a consistent visit billing rate for all invoiced visits that matches the reported rate on their Medicare claims can now enter this billing dollar amount in the new field “Invoice Rate Override”.  The Invoice Rate Override will display as the visit dollar amount on invoices.  The set up screens for Ohio Medicaid Tier rates and Unit Alternatives should remain completed as previously instructed for the software to calculate the actual units and payment dollar amounts.  The software will calculate the difference between the Invoice total using the Invoice Rate Override value and the actual visit amount calculated with the tier rates.  The difference will post as a contractual allowance when AR is updated.

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’.

Billing Tier rates are now available to accommodate rate calculation changes for Ohio Medicaid effective July 1, 2015.  Agencies should obtain the Main Office Software Version to be released at the end of the business day today 6/30/15.  Specific instructions are to follow.