Creating Level of Care Services for the Kipu RCM

Creating Level of Care (LOC) Services for the EMR + RCM integration is a five-step process that must be followed to ensure billable treatments are transmitted to the RCM correctly. Let's review who can create LOC services and the process they must follow. 

Required Permissions 

Users must be Super Admins in the EMR and, at minimum, an Organization Practice Admin in the RCM. For more information on creating users in the EMR, click here. For more information on creating users in the RCM, click here. 

Process Overview

When creating a new Level of Care service, a few crucial steps need to be completed for the services to map properly across the systems. Let's review those steps together!

In the EMR

The first two steps of the process start in the EMR: create the code and build the level of care. 

1. Create the Code

The EMR supports three types of codes: CCodes, RCodes, and HCodes. When billing institutionally, an RCode will always be required. However, HCodes are an optional. 

• In this example, the code Type is RCode, and the corresponding 4-digit number is in the Code field. 
  
• In this example, the code Type is HCode, and the corresponding 5-digit number is in the Code field. 
  

Click here for step-by-step instructions on creating Codes. 

2. Build the Level of Care

Create a new Level of Care for the PHP per-diem service. Levels of Care are configured under Settings > Patients. You'll notice that we selected the RCode and HCode we previously built and input the Type of Bill (Bill-Type Prefix)to finish building the LOC.  

Click here for step-by-step instructions on creating Levels of Care. 

In the RCM

Level of Care services are referred to as Authorization Required services in the RCM. Once a service has been created in the RCM, authorization requirements cannot be changed, and a new service must be made. 

3. Create the RCM UR-Required Service

Build the Service in the RCM by navigating to the Practice Admin > Services tab. 

When creating the service, it's important to: Select the correct Level of Care from the drop-down for reporting purposes. Toggle on the Attendance Calendar - Requires Utilization Plan or Service Rate setting. This requires the patient to have a U/R plan for this level of care before it can be billed.  Select the correct Kipu Level of Care Service from the drop-down. This list contains the Levels of Care configured in the Kipu EMR under Settings > Patients.

Click here for step-by-step instructions on creating a Service. 

4. Create the Service Billing Profile

Build the Service Billing Profile for the service to set the billing standards. 

When building the Service Billing Profile: Confirm the defaulted Claim Type to the Claim Format set in the EMR Level of Care (e.g., match institutional to institutional).   We recommend toggling on the Require Preferred Claim Type setting.  Enter the Institutional Revenue code, this should match the RCode added to the EMR Level of Care.  If used, enter the Institutional HCPCS/CPT code; this should match the HCode added to the EMR Level of Care.  Set the Institutional Bill Type Prefix; this should match the Type of Bill field in the EMR Level of Care.

Click here for step-by-step instructions for building Service Billing Profiles. 

5. Add Service Rate

The last step is to reference the service and set a service rate at each facility that should be able to bill this service. This occurs under Practice Admin > Facilities > Facility Service Rates.

Select the correct Service to generate the Service Billing Profile list and input the Institutional Unit Rate ($).

Click here for step-by-step instructions on setting facility rates.