Understanding Charges, Contracts, and Categories

Charges

Charges are entered on the Charges tab as you build your claims (incomplete workflow).

Because the system records the charge amounts you enter, that price per unit will display from that time forward on any claim with that charge type (HCPCS). Think of these amounts as your base or universal rates.

After you enter your rates, you can view and change them on the Charges tab under Settings.

Categories

For charges that are specific to a trip type, create a separate grouping (called category) on the Charges page. For example, if you charge more for transports in the mountainous Northwest Region, you can create a Northwest category with rates that are unique to trips to that region. You can also use categories to create rates with a start and end date.

Without a category defined, the Charges page only displays your base rates. Once you create a category, your base rates will show under the Universal category. In this example, you would see a Universal category with your base rates and a Northwest category with your Northwest Region rates.

When you work a claim, the system gives you the option to use your universal rates or apply rates from a category.

To find out more, go to Managing your Rates - Charges Tab .

Contracts

Categories and contracts are not the same and work differently in the system. While a category contains rates for your services and supplies that you charge for trips that fall within that category, a contract is an agreement with an insurance company or facility that defines the amounts that they will pay you for services and supplies every time you bill that payer or facility. Within ZOLL Billing, contractual amounts are associated with the payer or facility. When you send an invoice to a contracted facility, or submit a claim to a contracted payer, the system uses the configured contractual amounts to determine the expected payment.

Since they work differently, you never want to create a category for contractual charge rates.

For more information on contracts, see Contracts.