Payer Rules

Associating Payer Rules and Rate Schedules

After you accept Market Rates, you can associate Market Rate Templates to Payers in Payer Rules and Rate Schedules and use them to set room rates based on rate type or a percentage of a rate type. A Rate line must be manually created in Payer Rules and Rate schedules the first time that you use imported Market Rates. After that, the system automatically creates a new Payer Rule and Rate Schedule line when a Market Rate Template is accepted. Market Rate templates in Payer Rules and Rate Schedules allows you to define a percentage increase as well as a flat increase amount. 

From Admin>Setup>Payer Rules and Rate Schedules,

  1. Select Payer.

  2. If this is the first time you are using Market Rate Templates for this Payer, first create a new Rate Schedule with the same Schedule Start Date as the Effective From date in the Market Rate Template.

  3. Click edit rates on the rate line with the effective date that matches the Market Rate Import Effective From Date.

  4. Select Schedule.

  5. Select Unit Rate. All living units that are associated to the Unit Rate (Room Type) that you select are listed and available to set rates.

  6. Review/Complete the revenue and account information.

  7. In the Standard Rates section, click Use Market Rates.

  8. Enter Use Market Rates percent and select the Market rate type. This determines what Daily and Monthly amount is used for each room.

  9. If your organization records room and board contractual adjustments:

    • Click the Allow R &B Contractual Adj check box and select the GL Account.

    • Scroll to the Reimbursement Rates section and click Use Market Rates.

  10. Save.

  • Market Rates flow to new census and rate entries after the Market Rates Template is associated to a Rate Schedule. However, the Rate Schedule must be applied to update existing residents’ census and rates across facilities. If the rate schedules are not applied, residents still use the applied rates from the previous date range

  • Accepted rates must be applied in Payer Rules and Rate schedules to update existing residents’ census and rates history.

  • A Rate Schedule with the same Schedule Start Date as the Effective From date in the Market Rate Template must be manually created in Payer Rules and Rate schedules the first time that you use imported Market Rates.

  • After rates are applied, the rate template can no longer be deleted.