One thing that is always constant is change. As DODD continues to make changes to billing, we’ve been monitoring the impact the Monthly Rate Calculator will have on providers.

Over the course of 2019, DRA residential sites will transition to the new Monthly Rate Calculator and Monthly Billing Unit and we want to help make that transition smooth. When the transition occurs, providers will bill for all days an individual is a resident of the home, even if they are temporarily away from home. The only time a provider would not bill is if there was an admission to a nursing facility or ICF. 

To reduce the administrative burden of CPT adjustments for individuals living in DRA homes and to add predictability to providers’ revenue from DRA sites, DODD partnered with stakeholders to develop the Monthly Rate Calculator. By 2020, all DRA homes will be transitioned to using the new MRC tool.

There are some other important changes to note when using the MRC. Providers will want to consider the following tips and possible changes to their practices to ensure they are paid in a timely manner.

1. Preparing for annual meetings is even more important, now.

When you’re in the individual’s planning meeting, accurate staffing pattern projection become really important when using the Monthly Rate Calculator. As much as possible, schedules should be accurate for the month in which it was expected to be used. If schedules are not projected correctly, there is an increased chance that your billing will not fall into the 3% margin that will allow you to be reimbursed for the entire projected amount for the given month, which puts your claim at risk of not getting paid.

2. Be sure to accurately report service dates.

There is a significant change in the way billers report services when using the MRC. Now providers are expected to bill on the days where a consumer wasn’t present for the day, but was still a resident of the home. On the MRC, billers will be asked to indicate which days are not billable. According to DODD, “date of service, for the purpose of calculating the DBU, is any date on which the person is a resident of the home. A date of service includes days when the person is temporarily away from the home, as long as the person was not admitted to a nursing facility or intermediate care facility, also called an ICF.

3. Swiftly make adjustments and submit claims.

As sites transition to the MRC, we will have 30 days after the end of the service month to submit billing. This means ADL billing must be submitted in a timely manner to avoid missing a payment. 

In traditional DRA location, daily rate claims are adjusted on a daily basis. The Monthly Rate Calculator will alleviate the need for these adjustments as long as the rate falls within a 3% margin of the monthly projected rate. Adjustments to submitted billing will need to be completed within 60 days of the service month to the actual spans on MRC application. This means when your monthly rate goes above the 3% margin of error, it is a time-sensitive matter if you chose to contact the SSA and provide supporting documentation that additional hours were required, so that you can quickly get a new monthly rate calculated.

If you are a current Advisor user and would like assistance billing the Monthly Rate Calculator in your software, please contact the Customer Success Team at 614-430-0355, Option 3.

If you would like more information about Advisor please contact the Business Development Team at 614-430-0355.