Billing

Rate Modification: Yes or No

rate modification
rate modification

Considering an individual is eligible, should a provider elect to receive rate modifications?

To compare the cost-effectiveness of the two billing methods, let’s break it down:

Example A:

An individual, Cost of Doing Business Category 8, is eligible for the behavior rate modification, and is an A acuity.

  1. Daily Unit Billing: Rate $57.25 (5 hours of Adult Day Support)
  2. 15-Minute Unit Billing: Rate $62.20 (5 hours of Adult Day Support) = 20 15-minute units x ($2.29 + $0.82)

Comparing the two, the 15-Minute Unit Billing is more cost effective.

Example B:

An individual, Cost of Doing Business Category 8, is eligible for the behavior rate modification, and is a B acuity.

  1. Daily Unit Billing: Rate $103.50 (5 hours of Adult Day Support)
  2. 15-Minute Unit Billing: Rate $99.20 (5 hours of Adult Day Support) = 20 15-minute units x ($4.14 + $0.82)

Comparing the two, the Daily Unit Billing is more cost effective.

If you have questions, please Email Our Service Team.