Understanding the different types of Billing Categories

Understanding the different types of Billing Categories


What are Billing Categories?

Billing categories are the way CareVision groups related rate sets, allowing organisations to manage their rates and billing rules globally and change them over time with version control. CareVision includes several different types of billing category, each with their own unique capabilities for dynamic processing, including: 
  1. Time Categories to bill for booking time or on a per booking basis, these rate sets allow for various rates and rules for different time blocks such as public holidays, vs Saturday or Sunday, and will dynamically apply the rate based on the time of the booking. Our Time Category rate sets also allow for complex rules for when a booking starts in one time block and ends in another, and bracketing within the time block i.e. if a single booking is longer than 10 hours charge a different rate. 
  2. Travel with Client rate sets allow billing for distance or duration of travel tracked or reported within a booking. Different rates can be applied based on the total distance/duration.
  3. Call out Km rate sets allow billing for distance or duration of travel to a booking from a predefined set of locations. Different rates can be applied based on the total distance/duration, or multiple rates can be applied using a progressive bracketing system.
  4. Sleepovers & Interruption rate sets have a complex set of rules associated with them and allow for a different awake time / active time rate, allowances for the sleep period, rules around the sleep period and awake time durations, and rates that apply to interruptions for a detailed understanding of sleepovers please see collection of articles relating to sleepovers in this knowledgebase 
  5. Recurring Fees rate sets allow for recurring charges based on a frequency such as daily, weekly, monthly. It is important to note that these fees are anniversary based i.e. it will charge based on each anniversary of the frequency. 
Billing categories are also used to capture granular level references and reporting codes for NDIS (ref 4), CHSP Service Type ID (ref 3), income codes (ref1), and payroll related codes (ref2 and 8). 

In addition to each billing category type having its own set of rules there are also rate treatments which can be added to any rate and which will apply an uplift or a discount to the base rate based on certain criteria being met. There are two types of rate treatments: 
  1. Client Group (meta data) Treatments: these apply if a client has been added to a client group, some examples include adding a discount group, or a GST group to add GST to the base rate. Another example of this is where the organization charges different rate for the same service based on different sites or groups. 
  2. Client Leave Treatments: these apply if a client has been put on leave for a period of time. These treatments can be based on the number of consecutive days of leave or the total number of days of a type of leave in a financial year. While these support the home care rules, they can also be used for other recurring charges which may pause when a client is on leave. 

Basic Details of All Billing Categories

The mutual properties of a new Billing Category include Name, Type, Organisation Reference, and Archive Date which apply to all billing category types.


Once a Category Type is chosen, users will be able to put in Rate Sets and rules. While setting up Rate Sets for the Categories, users need to enter (1) an Effective From Date to activate the Category, (2) Reference numbers to support Export filtering in the later stage, (3) a Unit. Billing Categories can have: 
  1. Active Rate Set: There can be just one active rate set on each billing category at any one time. 
  2. Planned Rate Sets: There can be multiple planned rate sets at any one time. A planned rate set is one that has already been published with future effective from date
  3. Draft Rate Sets : There can be multiple draft rate sets at any time. A rate set will stay in draft until it is published. 
  4. Archived Rate Sets: These are a list of all the previously active rate sets which have been superseded by the latest rate set based on its effective date. 




Billing Category Types

Time Category

The Time Category billing category type allows billing per-booking or based on booking duration. Different rates can be charged based on the time that the booking was delivered based on rules called Time Categories. The default time categories include M-F Ordinary Hours, M-F Out-of-hours, Sat Ordinary Hours, Sat Out-of-hours, Sun Ordinary Hours, Sun Out-of-hours, and Public Holidays. Time categories can be customised and changed based on your organisation, and CareVision provides common and pre-set rules for some funding such as NDIS.

The order that time categories appear within a rateset is important. When processing a booking during the billing process, CareVision will only apply a single rate for each time category billing category. If multiple time categories match, CareVision will use the rate from whichever matching time category is specified within the rateset. Users can adjust the order of the time categories within a rateset by holding and dragging them to set the priority level.

It is important that public holiday time blocks are at the top of the list, the impact of having time blocks in the wrong order is shown on the example below, where the booking falls on a public holiday on a Monday at night. 
In the example below the rateset on the left has the time blocks in order with the public holiday at the top of the list, on the right the public holiday time block is half way through the list. On the left the billing engine matches 25th of April with a public holiday and uses the public holiday rate. On the right the billing engine will match 25th of April with a Monday Night before it gets to public holiday and as such it will use the rate for Weekday Night which would be wrong. As such it is important that you do not miss order the time blocks within the billing category. 



The time duration or Units is calculated in Hours, Minutes, or Bookings.  For each Service Booking, the first rate with a matching Time Categories is used in calculations. If a Service Booking time does match any of the Time Categories, then the system will apply the Default rate.

For Time Category only, users can set up Start Time Tolerance and Duration Tolerance (%) for Billing and Payroll, as Services with Time Categories charge according to the time. Additionally the Time Category also allow you to set a minimum billing quantity, which allows for services to be scheduled for shorter periods but to always charge a minimum duration. 


Distance Travelled with Client

Distance Travelled with Client calculates how much the client should pay for travel based on the distance or duration of travel within a booking. i.e. driving the client somewhere or traveling somewhere on their behalf.

While setting up Distance Travelled With Client, users set up rules with comparison operators for the distance that is "longer than", "longer than or equal to", "shorter than", and "shorter than or equal to" a certain number.

The Travel Duration blocks can also be manually moved around to adjust the order of the display. Just like with Time Categories, the order is important, as the billing engine will apply the first matching rate. 


Callout Distance

Callout Distance Billing Category Type allows for rate sets that calculate the distance or time of travel to get to an appointment from locations configured in the locations module.

The kms and duration will be measured from the nearest specified location and the start of the booking. For example some organisations have multiple sites, and would charge if a client is more than 10kms from the closest site, in this case they set up the sites as locations and have a single billing category for all sites, the system will calculate the closest site to the booking and work out which rate to charge.

Within Call Out Distance Billing Categories there are also two different rate set types,
  1. Progressive. - The total number of KMs will be charged for each matching bracket, if multiple brackets are involved there may be multiple charges, think of this like Income Tax Brackets
  2. Conditional - If the number of KMs matches to the bracket then the rate on the bracket will be charged

The Progressive Type set different rates for different distance brackets. Multiple rates are used in the calculation. According to the rules below, if the total Callout Distance is 10km, the total fees will be 3*$15+(5-3)*$12+(10-5)*$10 = $119; if the total Callout Distance is 4km, the total fees will be 3*$15+(4-3)*$12 = $57.



The Conditional Type of Callout Distance only applies 1 rate depending on the total distance. Users set up rules with comparison operators for the distance that is "further than", "further than or equal to", "shorter than", and "shorter than or equal to" a certain number. According to the rules below, if the total Callout Distance is 10km, the total fees will be 10*$10 = $100; if the distance is 4km, the total fees will be 4*$12 = $48.


Fees

These are being charged directly to the client or deducted on the funding available for the client. These costs varies depending on the client's eligibility, provider, level of care needed and services requested. Some cost may also be paid by the client, relative or friends and or the government though government contribution. Fees are of 3 types, including
  1. Funds In-Deduct, - Used for client contributions where the amount of fee reduces the subsidy from the government 
  2. Funds In-Add, - Used for client contributions and top up fees that add to the available funding pool for the client 
  3. Funds Out - Used for case and package management recurring fees as well as recurring accommodation or service charges
They are firstly set up as Billing Categories, later added as Fee Items, and finally added to a client's profile. If you are interested in more information, please read What are Fees, How can I use them, All the Options when Configure Fees Billing Categories and Fee Items.

While setting up Fees, users need to enter a Renewal Period, Value, and Unit of Value. The Renewal Period can be Daily, Weekly, Fortnightly, Monthly, Quarterly, Annually, or Once-Off. Unit can be Fee Amount or Fee %.


Users can also set up Client Group Treatments and Fee Leave Treatments to decide on the discount or fee rate for the Client Groups or Client Leave Types. If you are interested, please read Using Client Groups for GST Treatments and Using Client Leaves for Discount Treatments on Fees.


Sleepover

Sleepover Billing Categories are designed to be used in conjunction with Time Category Billing Categories. The Time Category billing category is applied for time outside of (before or after) the sleepover period.

Time during the sleepover period will be billed based on the contents of the Sleepover Categories section of the Sleepover billing category.



Whenever the client wakes up in the middle of the sleepover service, the staff member records an interruption. These interruptions are billed based on the contents of the Interruptions section within the Sleepover billing category.


For more details about the options within Sleepover billing categories, please read Sleepover Billing & Payroll.


Using Billing Categories with Services and Funding

In CareVision, the Billing Categories, Services, and Funding Sources are linked up with each other in Settings, forming rules around which rates can be used on which services, and under what funding arrangements. This helps to limit the options to show only related Services and Billing Categories, to the clients funding easier. Now that you have set up your billing categories, it is time to link them up to services and funding. Check out the Services and Funding articles for more details. 







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