Service Rates | Service Management | True Care System Documentation

Understanding Service Rates

A Service Rate is the monetary amount assigned to a specific service unit or billing format.

A rate should not be configured independently. It must correspond to the correct:

Provider.
Service.
Service Code.
Payer.
Program or waiver.
Ratio or zone.
Service level.
Unit format.
Modifier, when applicable.
Effective period.

Provider-Specific Rates

Service rates may differ from one Provider to another. Providers should not assume that another organization's rate applies to their own service configuration.

Rate differences may result from:

Different payers.
Different programs or waivers.
Different contracts.
Different state or regional requirements.
Different service levels.
Different staff qualifications.
Different ratios or zones.
Different unit formats.
Different effective dates.
Negotiated or provider-specific arrangements.

Provider Responsibility

The Provider must verify each rate against an approved source, such as a payer contract, fee schedule, program notice, authorization, rate letter, or other official documentation.

Service Rate Components

Component	Example	Description
Service	In-Home & Community Support Services	Identifies the service to which the rate applies.
Service Code	Provider-configured	Identifies the official billing or procedure code connected to the rate.
Level Type	Ratio	Indicates whether the service uses a ratio-based or zone-based configuration.
Level	1:1	Identifies the specific ratio, zone, or service level to which the rate applies.
Unit Format	Unit (15 min)	Defines how the service is measured and how the rate is interpreted.
Rate	$20.00	Stores the approved monetary amount per configured unit.
Payer	Provider-selected	Identifies the payer responsible for reimbursement.
Program	Provider-selected	Identifies the program or waiver under which the rate is approved.
Effective Date	Provider-defined	Indicates the date on which the rate becomes valid.
End Date	When applicable	Indicates when the rate is no longer valid.
Status	Active	Controls whether the service and its rate are available for new operational use.

Rate and Unit Relationship

The rate must always be interpreted according to the selected service format.

Unit Format	Rate Meaning	Example
15-Minute Unit	Rate per 15 minutes	$20.00 means $20.00 for each completed 15-minute unit.
Hourly	Rate per hour	$40.00 means $40.00 for each approved service hour.
Daily	Rate per day	$150.00 means $150.00 for each approved service day.
Mileage	Rate per mile	$1.25 means $1.25 for each approved mile.
Trip	Rate per trip	$35.00 means $35.00 for each approved trip.
Event	Rate per completed event	$75.00 means $75.00 for each approved service event.

Unit Accuracy

A correct monetary amount entered with the wrong unit format will produce an incorrect billing calculation. Always verify both the rate and the unit.

15-Minute Unit Example

When the service format is configured as Unit (15 min), each unit represents 15 minutes of service.

Configured Rate: $20.00 per 15-minute unit

Completed Service: 60 minutes

Units: 60 ÷ 15 = 4 units

Calculated Amount: 4 × $20.00 = $80.00

This example illustrates the mathematical relationship only. Actual billing may also depend on authorization limits, rounding rules, payer requirements, visit validation, documentation, and other billing controls.

Hourly Rate Example

Configured Rate: $40.00 per hour

Completed Service: 2.5 hours

Calculated Amount: 2.5 × $40.00 = $100.00

The result may be affected by the payer's rounding, minimum-time, maximum-time, or partial-unit rules.

Mileage Rate Example

Configured Rate: $1.25 per mile

Approved Mileage: 24 miles

Calculated Amount: 24 × $1.25 = $30.00

Mileage should be billed only when the service, authorization, documentation, and payer requirements support mileage reimbursement.

Rate by Ratio or Level

The same general service may have different rates for different service levels.

Service	Level	Format	Rate	Configuration Note
Community Support	1:1	15-minute unit	Provider-entered	Rate applies to one employee serving one individual.
Community Support	1:2	15-minute unit	Provider-entered	Rate may differ because one employee serves two individuals.
Community Support	1:3	15-minute unit	Provider-entered	Rate may differ according to the approved group ratio.
Transportation	Zone 1	Trip or mileage	Provider-entered	Rate depends on the approved zone and billing format.
Transportation	Zone 2	Trip or mileage	Provider-entered	A different zone may require a different rate.

The rates displayed above are intentionally listed as Provider-entered because the actual rate must be configured from the Provider's approved source.

Rate Is Not Employee Pay

The Service Rate is normally the amount used for service billing, reimbursement, invoicing, or operational financial calculation.

It should not automatically be interpreted as the employee's hourly wage or payroll rate.

Rate Type	Purpose	Example
Service Rate	Supports billing, reimbursement, invoicing, and financial reporting.	$20.00 per 15-minute service unit.
Employee Pay Rate	Supports employee compensation and payroll calculation.	$18.00 per employee work hour.

Separate Configuration

Employee compensation should be configured in the appropriate employee, payroll, or rate-management workflow. It should not be derived from the Service Rate unless the Provider has explicitly configured an approved relationship.

Rate and Service Code Relationship

A rate must correspond to the correct Service Code and level-specific configuration.

Before entering a rate, confirm:

The Service Code is correct.
The service name matches the code.
The payer is correct.
The program or waiver is correct.
The modifier is correct.
The ratio or zone is correct.
The unit format is correct.
The rate applies to the selected effective period.

Using the correct rate with the wrong code may still cause incorrect billing or reporting.

Rate and Authorization Relationship

An authorization identifies the service, approved period, approved units, and other service limitations for an individual.

The service rate does not replace the authorization. Both must be valid.

Before billing a service, the system or authorized reviewer may need to confirm:

The individual has an active authorization.
The authorization contains the correct service.
The authorization dates include the visit date.
Approved units are available.
The service code matches.
The service unit matches.
The visit is complete and valid.
The correct rate is effective.

Rate and Billing Relationship

Service Rates may be used when True Care System calculates or prepares billing information.

Billing readiness may depend on:

Valid individual information.
Valid payer and program configuration.
Valid authorization.
Correct Service Code.
Correct unit format.
Correct Service Rate.
Complete visit check-in and check-out.
Required EVV information.
Required service documentation.
Applicable billing rules.

A configured rate does not guarantee that a visit is billable. All required operational and payer conditions must also be met.

Rate and Reporting Relationship

Service Rates may support operational and financial reports, including:

Estimated service revenue.
Completed service value.
Authorization utilization.
Billing readiness.
Claim-batch totals.
Service-level comparisons.
Payer or program analysis.
Provider performance reporting.

Incorrect rates may cause financial reports to display inaccurate totals even when the underlying service time is correct.

Entering a New Service Rate

When creating a new service:

Select the correct Service Type.
Confirm the Service Name.
Enter or verify the Billing Code.
Select the Category.
Select Ratio or Zone.
Select the applicable level.
Enter the Service Code per Level, when required.
Select the correct Format.
Enter the approved Rate.
Confirm whether the service is billable.
Review the complete configuration.
Save the service.

Rate Validation Checklist

Complete the following review before activating the service:

The Provider is approved to deliver the service.
The service name is correct.
The Service Code is correct.
The payer is correct.
The program or waiver is correct.
The modifier is correct, when required.
The ratio or zone is correct.
The unit format is correct.
The monetary amount is correct.
The decimal placement is correct.
The effective date is correct.
The end date is correct, when applicable.
The billable setting is correct.
The rate source has been verified.

Effective Dates

Rates may change over time. The Provider should preserve the effective period associated with each rate.

For example:

Rate A is valid through December 31.
Rate B becomes effective January 1.
Visits before January 1 should retain Rate A.
Visits on or after January 1 should use Rate B.

Historical Accuracy

Do not replace an old rate in a manner that recalculates completed historical visits incorrectly. A new service record or effective-dated rate configuration may be required.

Updating a Service Rate

Before changing an existing rate:

Confirm the source of the new rate.
Confirm the new effective date.
Identify visits already completed under the old rate.
Identify open or scheduled visits.
Review active authorizations.
Review billing records not yet submitted.
Determine whether historical records must retain the old rate.
Determine whether a new service configuration is required.
Document the reason for the rate change.

Rate changes should be reviewed by authorized billing, administrative, or compliance personnel before production use.

When to Create a New Service Record

Creating a separate service record may be appropriate when:

The Service Code changes.
The payer changes.
The program or waiver changes.
The unit format changes.
The ratio or zone changes.
The modifier changes.
The rate changes with a new effective period.
The historical configuration must remain unchanged.

This approach helps preserve historical billing and reporting accuracy.

Inactive and Retired Rates

When a rate or service should no longer be used:

Set the appropriate end date, when supported.
Change the service to Inactive when it should not be selected.
Create the replacement service or rate configuration.
Preserve historical visits and billing records.
Review existing schedules and authorizations.

Do not delete a service record that has already been referenced by operational or financial records.

Common Rate Errors

Error	Example	Possible Impact
Wrong Unit	Hourly rate entered for a 15-minute service	Billing amounts may be four times too high or too low.
Wrong Decimal	$200.00 entered instead of $20.00	Billing and financial reports may be materially incorrect.
Wrong Level	1:1 rate used for 1:2 service	Billing may not match the approved service configuration.
Wrong Payer	Rate copied from another payer	Claims or invoices may use an unauthorized amount.
Wrong Effective Date	New rate applied too early	Historical or current visits may be calculated incorrectly.
Expired Rate	Old rate used after its valid period	Billing may not match the current approved amount.
Service Rate Used as Pay Rate	Billing rate copied into payroll	Employee compensation may be incorrect.
Missing Rate	Billable service has no rate	Billing preparation or financial reporting may be incomplete.

Service Rate Best Practices

Verify each rate from an approved source.
Confirm the correct Service Code.
Confirm the correct payer and program.
Confirm the correct unit format.
Confirm the correct ratio, zone, or level.
Use effective dates for rate changes.
Preserve historical rate information.
Review decimal placement carefully.
Do not copy a rate from another Provider without verification.
Do not use the Service Rate as an employee pay rate.
Restrict rate changes to authorized personnel.
Review rates regularly.

Security

Only authorized users should create or modify Service Rates.
Access to rates, codes, units, and billing configuration should follow assigned job responsibilities.
Rate changes should be reviewed by approved administrative or billing personnel.
Service Rate changes may be recorded in Audit Logs.
Unauthorized rate changes may affect billing, reimbursement, reporting, and financial operations.

HIPAA Considerations

Service Rate records should not contain individual-specific Protected Health Information.
Do not include individual names, diagnoses, or private information in rate fields or general service notes.
Access to services linked to individuals, visits, authorizations, and billing should follow the minimum necessary principle.
Protect financial and service configuration from unauthorized access or modification.
Preserve accurate historical records for compliance and audit review.

Troubleshooting

The correct rate is unknown.

Review the payer contract.
Review the applicable fee schedule.
Review the program or waiver documentation.
Review the Provider's rate letter.
Confirm the Service Code.
Confirm the unit format.
Confirm the service level.
Contact authorized billing or administrative personnel.
Do not enter an unverified amount.

The calculated amount is too high or too low.

Verify the Rate.
Verify the unit format.
Confirm whether the rate is per hour or per 15-minute unit.
Verify the completed service duration.
Review rounding and partial-unit rules.
Confirm the ratio or service level.

The rate does not appear during billing.

Confirm that the service is Active.
Confirm that the service is marked billable.
Confirm that a valid Rate is entered.
Confirm the effective date.
Confirm the Service Code.
Confirm the visit uses the correct service.
Confirm the authorization uses the same service.

A new rate was applied to old visits.

Review the rate's effective date and historical configuration. Restore the previous historical rate or create a separate effective-dated service configuration as appropriate.

The Service Rate and payroll amount do not match.

This may be expected. The Service Rate is generally used for billing, while payroll uses the employee's compensation rate and payroll rules.

Frequently Asked Questions

Does every Provider use the same Service Rate?

No. Rates may differ according to payer, program, waiver, contract, state, location, service level, unit, and effective date.

Can I copy a rate from another Provider?

A rate should not be copied without verification. The other Provider may have a different contract, payer, program, or approved rate.

Is the rate entered per hour?

Only when the selected format is hourly. When the format is Unit (15 min), the rate is interpreted per 15-minute unit.

Is the Service Rate the employee's pay rate?

No. The Service Rate is generally used for billing or financial calculation. Employee compensation is managed separately.

Can one service have multiple rates?

Yes. Different rates may apply to different ratios, zones, levels, payers, programs, modifiers, units, or effective periods.

What happens when a rate changes?

Confirm the new effective date and preserve the rate used by historical visits. A new service or effective-dated configuration may be required.

Should an expired rate be deleted?

Normally, no. Preserve historical rate information and prevent the expired rate from being used for new services.

Can a service be billable without a rate?

The service may be marked billable, but billing calculations may be incomplete or unavailable until a valid rate is configured.

Who should approve a rate change?

Rate changes should be reviewed by authorized Provider personnel using official payer, program, contract, authorization, fee schedule, or rate documentation.