Rate Calculations and Billing Units

When a service is entered with all required fields completed, the rate for the service will be automatically calculated based on the Procedure/Rates set up in the system.

The rates are set up in the background to calculate automatically based on the clinician’s license/degree and other criteria set.

To accommodate the new CalAIM billing guidelines, the units for services that require rounding have been configured in SmartCare. Clinicians will continue to enter the Face to Face time for services with clients, and SmartCare will automatically calculate the correct units for billing based on the rounding that has been set up.

A Procedure that is set to round as “Per 15(7/7),” rounds off to the next multiple of 15. If the service provided is 7 minutes or less, the billing unit = 0. If the service is between 8 and 22 minutes, the unit = 1.

  •  8-14 minutes is rounded up to 15 minutes
  • 16-22 minutes is rounded down to 15 minutes

Once the number of minutes for any 15 minute increment reaches the 8th minute the unit will be rounded up to the next whole unit.

  1. Workflow for Rate Calculations Service is recorded by a clinician or other staff member
    1. Service is in a ‘Show’ status
    2. System will match to a Rate ID and calculate the Charge amount, but the charge has not been created yet
  1. Overnight Service Completion job runs and looks for all services in a ‘Show’ status
    1. If the service has no warnings or errors the service will be completed
      1. Service is now in a ‘Complete’ status
      2. The charge has been created and a ledger entry now exists for the charge