When a medication is added to the Medication Information Configuration grid, the Billing Rules grid displays a default standard rule and a default special rule that apply to all financial classes (as designated by an asterisk) and all payers,of 1:1 Quantity-to-Billing Unit.
- Standard Rules are ratios of billing units per quantity of medication given. There may be a single standard rule, or different rules defined for different financial classes or payers.
- Special Rules are ratios used for billing when the J-Code changes depending on the medication quantity given (For example, as for Depo-Medrol).
You cannot remove either default all-payer rule, but you can:
- Edit the Quantity-to-Billing Unit ratio for a default all-payer rule
- Add either standard or special rules for individual financial classes and payers
- Update added rules
- Delete added rules
Note: You cannot set up special rules for a medication for which you have already set up a standard rule, nor set up standard rules for a medication for which you have already set up a special rule.
