Has your company been using CPR+ since Jeff was answering tech calls?  Did you start the new millennium with the price codes that are currently in your system?  Do you find yourself going into every single inventory item to make pricing changes? Did you know that there is a way to modify your list price without ever going into inventory?

The Price Codes are truly the backbone of your CPR+ system build. The price codes are used to calculate your list price and also set up your Special Price Matrices for your insurance companies. Have you ever looked at an inventory item and wondered what those numbers in parenthesis were next to the list price? That is your Price Code formula: it matches the price code that is assigned to that inventory item.

So, where are these mysterious price codes, you ask?  From the Main Menu, choose Billing / Financial (5) and select Set Up Price Codes (B). Did you notice that you can enter up to fifty price codes? Fifty Price Codes!  Now, you’re feeling a little overwhelmed, right?  Well, don’t!  I mean seriously, when you’re using the most user-friendly system in the industry, you know it isn’t going to hurt that bad.

When you install CPR+, your Price Codes screen will look like this:

CPR+ has four default price codes:  01 – Drugs, 02 – Supplies, 03 – Rentals, and 04 – NIBI’s. When a drug is entered into inventory, the price code 01 is assigned to that item by default, 02 is assigned to Supplies, 03 to Rentals, and 04 to NIBI’s.

So, what about the other forty-six?  Take a look at your payor contracts. Are there any items that are “carved out” from the normal reimbursement rate?  For example, are your enteral formulas reimbursed at a different rate than your antibiotic therapies?  Is that the case on eighty percent of your contracts?  If so, then you will want to create a Price Code for Enteral Formula and then assign that code to the corresponding items in inventory to ensure that the list price is calculated correctly. Examples of other items that we commonly see as “carve outs” are: IVIG, TPN (Bases / Electrolytes), Fluids (Diluents), and Flushes. You can also have “carve outs” within your supplies. If there are certain supplies that you would never be reimbursed for – maybe they are always included in the per diem; you may want to create a price code for these so they could be set as Non-Billable in the Special Price Matrix.

The price codes serve a two-fold purpose. The first is the formulation for the list price; the second purpose is to create the formulas for the Special Price Matrix or Contract. Do you have payors that require you to bill at list price, but then have a negotiated reimbursement rate?  Or, do you have any payors that want to be billed at a rate other than your list price? Sure you do! So, to set those up, go to the Insurance Company Setup screen, highlight the insurance company, and click the Pricing (F6) button. Once the matrix is created and displayed on your screen, you will want to select Fill Prices (F3). This is where you can set up formulas for your Special and/or Expected Prices. At this point, a price code can also be set as Not Billable and an authorization requirement can be defined. Creating the formulas for the Special and Expected Prices is exactly the same as entering the formula for the price code. Once these are defined, you can fill your matrix and begin billing your payors at the correct rate and also accurately represent your A/R.

Wow, I’m so excited for you guys! Now you have the tools to correctly (and easily) define your list prices and significantly reduce the amount of contractual adjustments in your system!

To learn more about the Price Codes or any of the awesome functionality that will save your company time and money, contact the CPR+ Training Department today to discuss the many training alternatives that we offer!

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Question: What is the most convoluted set of billing rules in home health care? The Medicare rules for billing rental items is at the top of my list. Is it a capped rental item, or just treated like a capped rental item? When is the item converted to a sale? For the answers to these and other questions, we will be including a class on Recurring Rentals Management during this year’s CPR+ User Conference.

This class is designed to review all of the Medicare policy functionality built into the Recurring Rentals Manager, as well as to review the process for editing items, creating multiple line items and creating claims. Additionally, we will review the Recurring Rental auto-creation process.

Did you know that version 8.1a of CPR+ will include an exchange ticket? This class will cover how the exchange ticket updates the Recurring Rental record. Pickup Tickets and Stop Dates will also be covered in this class.

So, do you remember the 4, 10, 13, 15, 22, 36 policies of Medicare? Come to the class for clarification and renewed confidence in your recurring billing.

See you at the conference!

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