A function to automate Room and Board charges is available only in Hospice mode. In order to automate Hospice Room and Board charges, changes must be made to Master Files. If Room and Board charges will be processed manually, the changes outlined below do not need to be made.
State specific Medicaid setup requirements are detailed in the Medicaid Guide.
Create a single Room and Board service with a Revenue Code of either 658 or 659, Texas providers will need to have a Service Master listing for each Rug/Tile rate billed. There is no need to enter a rate on the Edit Details screen - the Facility Rate will override this when billing is processed. Enter the HCPCS code and Revenue Code that is most commonly required by Room and Board payor(s).
Service Detail Overrides for Revenue codes and HCPCS can be set up at the payor level for providers with multiple Room and Board payors.
Room and Board payors should have the following settings in Master Files | Payors / Plans. Settings in the Billing Formats tab will vary state to state. Please consult the state Medicaid payor or provider manual to determine proper setup. Most states will require UB04 format, with the exception of Ohio Medicaid, Virginia payors, and some commercial payors. Please contact the payor to help determine correct format type.
Recommended settings:
● Payors tab — Payment Source must be set to Medicaid Room & Board.
● Plans tab — Group/Plan # and Provider # must be identical (Numeric characters only).
● Billing Formats tab — Refer to the next two sections for settings on UB04 and 1500 claims.
● Form Type = UB04
● In Medicaid section, check Calculate Covered Days (Use state guidelines to determine if you must also check Exclude Date of Revocation or Exclude Date of Death).
● In National Provider Identifier section, check both Use Doctor’s NPI and Use Provider’s NPI boxes.
● Form Type = 1500
● Check Create Claim with Billable Days Itemized.
● In Medicaid section, select the State Form for the state being billed.
● In National Provider Identifier section, check only the Use Doctor’s NPI box.
In order to synchronize properly throughout the software, each location code must have the Nursing facility checkbox selected in Reference File | Location Codes. For Room & Board automation, the location for the facility must match the location code for patient’s level of care.
Specific facility services and rates can be added from the Rates tab (in Master Files | Facilities). Rates can only be added if the facility has a “Hospice” Line of Business and the corresponding location code is indicated as nursing facility.
To add rates:
1. Using the main menu, navigate to Master Files | Facilities.
2. Highlight the desired facility in the Nursing Facilities display grid.
3. Select the Rates tab. The screen will default in new mode.
4. Select the appropriate Room & Board service from the display grid to set the specific rate for the selected facility. This list is populated from Master Files | Service Master and will display all services with the Revenue Code = 658 or 659.
5. Enter the Effective From date and Fee details.
6. Click Save.
Patient Level of Care — Facility Rate Application
In order to automate Hospice Room and Board charge creation, rates must be applied in the level of care screen for the patient.
To apply facility rates for a patient’s level of care:
1. Select the appropriate patient within the Patients area.
2. Using the main menu, navigate Patients | Admission / Discharge | Level/Location of Care.
3. Select the appropriate Nursing Facility where the patient is located. The location of care must have the Nursing Facility checkbox selected in Reference Files | Location Codes to display in this field.
4. Click Save.
5. Click New within Facility Rate Applied/Dates section header. There may be multiple rate options for each facility. Use the Rate/Fee drop-down field to select the appropriate rate for this patient. The rate amount and effective dates will display next to this field. Ensure the correct rate is selected.
6. Enter a Begin date. The End date can be left blank. It will populate automatically when a new rate is applied or the Level/Location of Care is changed.
7. Click Save within the Facility Rate Applied/Dates section header.
Rate adjustments can be applied to adjust the amount due on the patient’s accounts receivable for faster payment posting. Entering a positive amount will decrease the daily rate shown due in the patient’s accounts receivable and a negative amount will increase the daily rate.
To apply rate adjustments from within Patients | Admission / Discharge | Level/Location of Care:
1. Click New within the Rate Adjustment box (if not in new mode).
2. Enter the Begin date.
3. Select the Adjustment Reason.
4. Enter the Amount for the rate adjustment.
Once rates have been assigned for each patient (using the steps on the previous page), a batch for the Room & Board payor (or its financial class) can be created. When the batch is created, all days and charges for Room & Board will pull into the batch as were indicated by level of care entries.
Room & Board charges will no longer need to be entered in Accounts | Charge Entry screen for patients.