How DDCS Billing Works
Washington's Developmental Disabilities Community Services (DDCS) program bills services in 15-minute increments, called "units." Understanding this system is critical for agency revenue and compliance.
The basic math:
- 1 unit = 15 minutes
- 4 units = 1 hour
- 8 units = 2 hours
Sounds simple, right? The complexity comes in the details.
The Rounding Rules
Medicaid has specific rules about how to round partial units. In Washington, the standard approach is:
- Less than 8 minutes: No billable unit
- 8-22 minutes: 1 unit (15 minutes)
- 23-37 minutes: 2 units (30 minutes)
- 38-52 minutes: 3 units (45 minutes)
- 53-67 minutes: 4 units (1 hour)
This pattern continues for longer visits.
Example: A 73-Minute Visit
Let's calculate:
- 73 minutes ÷ 15 = 4.87 units
- Since the remainder (13 minutes) exceeds 7 minutes, round up
- Billable: 5 units (75 minutes)
Example: A 51-Minute Visit
- 51 minutes ÷ 15 = 3.4 units
- Since the remainder (6 minutes) is less than 8 minutes, round down
- Billable: 3 units (45 minutes)
Common Billing Mistakes
Mistake 1: Manual Calculation Errors
When staff calculate units by hand, errors happen. A caregiver might:
- Round incorrectly
- Miscalculate visit duration
- Transpose numbers
Over time, these errors add up to significant revenue loss—or compliance risk if you overbill.
Solution: Automatic unit calculation from verified time data.
Mistake 2: Missing Partial Units
Some agencies only bill whole hours, leaving money on the table:
- A 50-minute visit billed as 45 minutes loses 1 unit
- A 1 hour 40-minute visit billed as 1.5 hours loses 2+ units
Solution: Capture exact minutes and calculate precise units.
Mistake 3: Exceeding Authorized Units
Each client has authorized units per month for each service type. Exceeding authorization means:
- Unbillable services
- Compliance violations
- Unhappy case managers
Solution: Real-time tracking of used vs. authorized units.
Mistake 4: Service Type Confusion
Different service types have different rates and authorizations:
- Community Engagement (CE)
- Specialized Habilitation (SH)
- Staff-Family Consultation
Billing the wrong service type is a compliance issue.
Solution: Clear service type selection with built-in validation.
Tracking Authorization Balances
Effective billing requires knowing, at any moment:
- How many units has this client used this month?
- How many units are authorized?
- How many units remain?
- Are we at risk of exceeding authorization?
The Manual Way
Check the authorization letter, review all past time entries, calculate total used, compare to authorized amount. Repeat for every client, every month.
This is time-consuming and error-prone.
The Automated Way
Modern systems track in real-time:
- Dashboard view: All clients with authorization status
- Alerts: Warning when approaching limits
- Automatic blocking: Prevent scheduling beyond authorization
- Reports: Authorization utilization by client, service type, period
Unit Billing and Family Communication
Families often don't understand unit billing. They might wonder:
- Why was my loved one's visit only 45 minutes?
- Why are we running out of authorized hours?
- How are services being used?
Transparent reporting helps:
- Show families exactly how units are being used
- Explain when authorization is running low
- Demonstrate value of each visit
Maximizing Authorized Units
Authorized units are precious. Here's how to use them wisely:
Efficient Scheduling
- Minimize travel time between appointments
- Group appointments geographically
- Schedule consistent recurring visits
Appropriate Service Matching
- Use the right service type for each activity
- Don't over-schedule low-value time
- Focus on meaningful engagement
Timely Documentation
- Bill promptly to catch errors early
- Reconcile weekly, not monthly
- Address discrepancies immediately
The Revenue Impact
Let's look at how unit billing accuracy affects revenue:
Scenario: 50 clients, average 20 hours/month each
| Issue | Lost Units/Client/Month | Total Monthly Loss | |-------|------------------------|-------------------| | Rounding errors | 2 units | 100 units | | Missing partials | 1 unit | 50 units | | Scheduling gaps | 3 units | 150 units | | Total | 6 units | 300 units |
At approximately $15 per unit, that's $4,500 in monthly revenue loss from billing inefficiency alone.
Over a year: $54,000.
Getting Unit Billing Right
The agencies that bill accurately have:
- Automatic time capture: No manual entry of hours
- Real-time calculation: Units computed as visits happen
- Authorization tracking: Know limits before they're exceeded
- Clear reporting: Easy review of billing data
- Audit trail: Documentation for compliance
Technology handles the math. Your team focuses on care.