Create and Manage Facility Rates

Each service created in the RCM must have at least one billing profile. These profiles instruct the system on how to make the claim based on the service recorded. Because a service can have more than one billing profile, each profile created must be referenced at the facility to ensure the correct service rate is applied. 

User Permissions

Only users with admin-level profiles can configure and manage facility rates. For more information on user profiles and permissions, click here. 

Section Overview

The Facility Service Rates section displays all services and their respective billing profiles that have been referenced at the facility. This includes the service name (and its billing profile), the unit rate for each type of service, and the service rate type. The rates referenced are used to calculate the total charges on a claim unless the patient has a single case agreement.

Create and Manage Facility Rates

Let's review how to create and manage facility rates!

• 1. In the Practice Admin, click Facilities.
      
  2. Next, click the Facility Name to open its profile.
      
  3. Click Facility Services Rates.
      
  4. Click Add Service Rate.
      
  5. Select the Service.
     
     
  6. Then update the Billing Profile drop-down.
     
  7. Next, enter the Unit Rate in the corresponding claim form type field. For example, the rate of a standalone service with a professional billing profile should be referenced in the Professional Unit Rate field.
      
  8. When applicable, update the Service Rate Type before clicking Add to complete the process.
      
• 1. In the Practice Admin section, click Facilities.
      
  2. Next, click on the facility name to open its profile.
      
  3. Click Facility Service Rates.
      
  4. Then select the desired service name.
     
  5. Click Create Schedule Change Set to adjust the rate from a specified date.
      
  6. Enter the effective date of the change and click Save.
     
  7. Then, click the pencil icon next to the effective date.
     
     
  8. Make the necessary changes and click Save to complete the process.