Notes Regarding HMO Billing For Multiple Insurances
[ CC, 14, 13 – HMO Billing Information ]
An alternate methodology has
been developed to allow customized billing to HMOs and other insurances.
A user can specify up to four insurances and the amounts being paid by each insurance at any point during a resident stay in the
facility. A deductible can be specified, and billing can be Rug based.
Following is an
example:
Resident is admitted
HIP pays 500 a day for days 1 thru
10, and 400 a day for days 11 – 120.
Co-insurance of $100 a day is
split 75% Blue Cross and 25% Private.
Notes:
The HMO Billing date entered
above
must be either the: resident’s admission date, or the date the billing status
changed.
The primary bill type on the HMO Billing Information screen is set to the
primary bill type of the admission or the change in status date.
If the Primary billing type
uses a Rugs rate based on the MDS assessment, enter an ‘R’ in the Type field
(rates should not be specified for the primary bill type.)
If the secondary insurances
pay is based on
a percentage of the payment amount of the primary insurance enter a ‘P’ in the
Type field for the secondary insurance and a payment percentage instead of the
amount.
The remainder of the billing
process remains unchanged. Run the Post Room and Board Charges program [AR, 2,
1] to list and post charges.
