Files > RATE SCHEDULE

name

RATE SCHEDULE

number

363

location

^IBE(363,

description

A Rate Schedule defines a specific type of service that may be billed to a specific payer. This links all elements necessary to define exactly what events are billed (Charge Set) to which payers (Rate Type). There should be a unique Rate Schedule for each type of service billable to a payer.

Fields

#	Name	Location	Type	Details	Index	Description
.01	name(+)	0;1	FREE TEXT		B	A Rate Schedule which defines a set of charges billable to a payer for a specific type of service. This is a free text short description that should identify who and what is being billed.
.02	rate type(+)	0;2	POINTER	399.3		The Rate Type of the bills the charges of this schedule should be applied to.
.03	bill type(+)	0;3	SET OF CODES	1:INPATIENT 3:OUTPATIENT		The type of care being billed or type of bill the charges of this schedule are for.
.04	billable service	0;4	POINTER	399.1		The type of service covered by the charges of this Rate Schedule.
.05	effective date	0;5	DATE-TIME			The first date the charges associated with this Rate Schedule may be billed to a payer.
.06	inactive date	0;6	DATE-TIME			This is the last date this Rate Schedule may be used to bill a payer.
1.01	dispensing fee	1;1	NUMERIC			This dollar amount is the dispensing fee component of the rate schedule adjustment that was entered.
1.02	administrative fee	1;2	NUMERIC			This dollar amount is the administrative fee component of the rate schedule adjustment that was entered.
10	adjustment	10;E1,245	FREE TEXT			This allows the base charges of a rate to be adjusted for specific types of payers. Modifies the Unit Charge of all items assigned to this Rate Schedule. For Example, this would be used to bill a certain type of payer only 80% of the CMAC. Or to add a $2.50 fee to each prescription. This is a line of M code and should only be modified by an M programmer. Once the Unit Charge is determined for a billable item, this code is executed to modify that charge. This modified charge is what will be added to the bill. When this code is executed: - the original value of the Unit Charge will be in variable X - the modified charge to be billed should be returned in variable X Use the local namespace for any other variables needed and kill them. To charge 80% of the Unit Charge: S X=X*.8 To add a $2.50 fee to the Unit Charge: S X=X+2.5
11	charge set	11;0	MULTIPLE	363.0011		All Charge Sets for this Rate Schedule. These define all the charges that may be billable to the payors for a specific type of bill.