Transmitting Billables for Private Pay/Non Insurance Patients

To bill a level of care (per-diem billing) for a private pay/non-insurance patient, you can use Clinical Level of Care. When a clinical level of care is added to the patient and the payment method on their facesheet is set to a Non-Insurance Type, the appropriate Level of Care codes will populate on the Billing Report for billable items. You do not need to add an authorization from the Utilization Reviews section. 

Note: This workflow is designed for users with CollaborateMD or HL7 Billing and only applies to non-ancillary items (e.g., billable Group Sessions and Evaluations not marked as ancillary). For instructions on billing using Clinical Level of Care for Avea integrations, click here. 

Clinical Level of Care Billing Workflow

Level of Care

Ensure that your organization has the desired levels of care configured. Click here for instructions.

Payment Method 

Ensure you have at least one payment method set up that has the Non Insurance or Private Pay category.

1. To confirm this, Super Admins can navigate to their Initials > Settings > Patients.
2. Scroll to the Payment Methods section and create or set at least one category to Non Insurance or Private Pay.
   
   1. Important: It is vital to note that while you can edit the names of any existing payment methods if these names are changed, any patients with the original payment method selected will now have no payment method selected.

Patient Setup

Ensure the Payment Method selected on the patient facesheet is set to a Non-Insurance or Private Pay method. 

1. Open the Patient chart and click Edit Patient.
   
2. Confirm a Non-insurance or Private Pay method is selected.

Add Clinical Level of Care

From the patient chart, locate the Evaluation that allows Clinical LOC assignment. Please note: This can be any Evaluation form with the patient.level_of_care_clinical field. 

1. To start, click on the Add Document icon. 
2. Search for the document and click the Edit icon to add and open.
3. Select the desired Level of Care and complete the document as needed. Sign and Submit.
   
4. The Clinical LOC displays in the header of the patient chart. 
   

Add Billables 

Next, add billable Group Sessions or Evaluations to the patient. Evaluations and Group Sessions that are added during the same date range as the patient's assigned Level of Care will automatically bill using the LOC billing code and duration requirements. Remember, any items marked as billable and ancillary will bill using the code selected for the billable item and are billed separately from the LOC (per-diem) items.  Click here to learn more about billable items. 

Billing Report

For all per-diem items (billable, not marked ancillary), the clinical level of care will pull into the billing report with the related codes and duration.