Complex Billing Rules (Article)

Overview

TreatAnyone supports standard rate allocations between referral sources and clients so that an offering can be partially billed to each party based on a percentage or an absolute dollar amount. But what happens when a given client needs to follow a different allocation scheme or has a bespoke payment arrangement that doesn't adhere to the standard rate configuration. For example, what happens when a client will copay 50% for group session for the first three months, but then go back to paying the full rate? 

This is precisely the Complex Billing feature addresses. 

Defining Complex Billing Rules

To define a new Complex Billing Rule, navigate to the client's Enrollment profile and find the Billing Rules section. 

From here, click on the ADD RULE button and fill in the requested information into the dialog box. 

All Rates vs. Specific Rates

A biling rule can apply to all rates, or only the specific rates you choose. Click on the CHANGE button to select specific rates for which you would like to configure special billing rules.  

Payment Allocation 

The central part of configuring complex billing rules is deciding the rate allocation between the client and possibly multiple other payers. To select the desired payers, click ADD PAYER and select additional payers from the drop down. It is unusual to have more than two payers in addition to the client. 

Once selected, used the drag handles to adjust the order of payment precedence. This is important particularly when the allocation is based wholly or in part on absolute amounts. In case the total of the offering totals less than the discounts, some parties on the list could end up paying $0. For example, if the offering rate was only $65 in the example below, Client would be charged $50, and Organization would be charged $15, as the total of the two is $65. $0 would be allocated to Alco Probation in this scenario.   

Effective Dates

The final step in defining a Complex Billing rule is to determine the date range when that rule will be effective. Click on the appropriate option in the Effective Dates section and enter the desired dates. Remember that the dates entered in this section are inclusive and that two different billing rules can not overlap. 

Billing Rules Examples

The easiest way to think about the way Complex Billing rules work is to remember that the allocation defined at the client level completely overrides the allocation defined at the Config level for a given rate in the Rules section, as illustrated below. 

With Complex Billing defined at the client level, TreatAnyone calculates the resulting rate and payment allocation by applying rules in the following order: 

1. Config-level rules associated with the rate in Premiums and Discounts section, as these rules depend on attendance statuses for group and individual sessions. 
2. Named or overall discounts defined for the client. 
3. Allocation rules defined at the client-level in the Enrollment Profile. 

Billing Example 1

Config-level definition:

• Rate is $150 per item

• Org pays 100%

• Noshow, rate is $0

• Late, rate is +$10 (premium or penalty)

Client-level definition:

• Overall discount of 10%

• Allocation rule: CDCR pays $40, BCBC 30%, client Remainder

• The client’s attendance status was Late

Process:

1. Apply the Late rule, making the rate $150 + $10 = $160

2. Apply client-level named discount of 10%: $160 - ($160 * 10%) = $160 - $16 = $144

3. Allocate the final rate:

   1. Bill CDCR for $40

   2. Bill BCBC for ($144 - $40) * 30% = $104 * 0.3 = $31.20

   3. Bill client the remainder: $144 - $40 - $31.20 = $72.80

Billing Example 1

Config-level definition:

• Rate is $150 per item

• Org pays 100%

• Noshow, rate is $0

• Late, rate is + $10 (premium or penalty)

Client-level definition:

• Overall discount of 10%

• Allocation rule: CDCR pays $200, client Remainder

• The client’s attendance status was Late

Process:

1. Apply the Late rule, making the rate $150 + $10 = $160

2. Apply client-level named discount of 10%: $160 - ($160 * 10%) = $160 - $16 = $144

3. Allocate the final rate:

   1. Bill CDCR for the full $144 since they cover up to $200

   2. Bill client the remainder: $0.00