Creating Level of Care Services for the Kipu RCM (Avea)

  • Updated

Level of Care services in the Kipu EMR are referred to as UR-Required Services in the Kipu RCM (Avea). When creating a new Level of Care service, there are a few crucial steps that need to be completed in order for the services to map properly across the systems.

Required Permissions: Users must be Super Admins in the EMR and at minimum an Organization Admin in the RCM to complete the following steps.

At a high-level, this process includes: 

  1. Creating Codes in the EMR
  2. Building the Level of Care in the EMR
  3. Create the matching UR-Required Service in the RCM.
  4. Set up the associated Billing Service Profile in the RCM.
  5. Add the Service Facility Reference in RCM.

Process Walkthrough

You can click through the process for adding a Level of Service in the simulation exercise below. Please use the fullscreen button (lower-right) if you have a hard time seeing the steps. 

78 STEPS

1. Let's start by creating your billing codes for the Level of Care. From the Kipu EMR, click on the initials in the top-right corner.

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2. Click Settings.

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3. Click Billing.

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4. Click Codes.

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5. Next, let's update our coding system for the institutional level of care. Click CCode under the Coding System drop-down.

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6. Select RCode.

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7. Click Add item.

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8. Click Code and we'll enter our RCode.

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9. Click Description and we'll complete it for you.

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10. From the Effective Date field, choose 1.

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11. Click Submit.

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12. Next, let's update the Coding System again. Click RCode.

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13. Select HCode.

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14. Click Add item.

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15. Click on the Code field and we'll enter it for you.

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16. Click on the Description field and we'll add it for you.

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17. Next, click on the Effective Date field.

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18. Click 1.

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19. Click Submit.

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20. Now that we've built out our codes, let's create the Level of Care. Click Patients.

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21. Scroll down to the Levels of Care section. Click Add item to add a new Level of Care.

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22. Click Level of Care Name field and we'll add the name.

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23. Click the Billable checkbox.

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24. Next, click on the LOC Type drop-down.

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25. Select Attendance Based (PHP/IOP).

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26. Next, check the Sun checkbox and we'll check the rest for you.

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27. Click on the HCode drop-down.

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28. Select the S0201 code we previously built.

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29. Next, click on the RCode drop-down.

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30. Select 0913.

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31. Click into the Hours field and we'll add the minimum hours required to bill this service.

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32. Place of service is required for Professional Claims and is not required for Institutional.

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33. Next, click on the Claim format drop-down.

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34. Select Institutional.

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35. Click Type of bill field and we'll complete it for you.

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36. Click Locations.

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37. Choose the locations that will use this service. Click Alhambra Recovery.

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38. Click Coral Gables Programs.

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39. Click Locations to close.

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40. Click Update to save.

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41. Next, we'll open AveaOffice to add the matching level of care service. Click Admin.

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42. Click Practice Admin.

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43. Click Services.

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44. Click Create Service.

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45. Click into the Name field and we'll complete it for you.

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46. Next, click to complete the Service Description on Patient Statement field. This field is only available for organizations who have purchased Patient Billing.

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47. Click on the Level of Care drop-down.

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48. Select PHP.

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49. Click the Attendance Calendar - Requires Utilization Plan or Service rate toggle.

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50. Click on the Kipu Level of Care Service drop-down.

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51. Select PHP to map the EMR Level of Care we created to this Avea Service.

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52. Click CREATE.

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53. Next, we need to add the Billing Service Profile. Click PHP.

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54. Click Billing Profiles.

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55. Click Create Service Billing Profile.

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56. Click into the Profile Name field and we'll complete it for you.

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57. Click Claim Form Service Name field and we'll complete it for you.

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58. Click to toggle on the Require Preferred Claim Type field.

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59. Click on Institutional Revenue Code to add in the RCode the field.

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60. Click on Institutional HCPCS/CPT Code to add the HCode.

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61. Click on the Institutional Bill Type Prefix to add in the type of bill.

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62. Professional Place of Service isn't needed for Institutional claims.

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63. Click on the Allow Multiple Services Per Claim toggle.

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64. Click on the Itemize 837I Claims toggle to allow itemization for these services.

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65. Click CREATE.

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66. Next, let's add our Facility rates. Click Admin.

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67. Click Practice Admin.

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68. Click Facilities.

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69. Click Coral Gables.

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70. Click Facility Services.

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71. Click Add Service Reference.

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72. Click on the Service drop-down.

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73. Select PHP.

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74. Click on the Service Billing Profile to choose the billing profile we just created.

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75. Select All Payers.

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76. Click into the Unit Rate field and we'll complete the rate for you.

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77. Click ADD.

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78. That's it for creating Level of Care services in the EMR and Avea.

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** Best experienced in Full Screen (click the icon in the top right corner before you begin) **

https://www.iorad.com/player/2206302/Creating-Level-of-Care-Services--Avea-Integration-?iframeHash=trysteps-1

 

78 STEPS

1. Let's start by creating your billing codes for the Level of Care. From the Kipu EMR, click on the initials in the top-right corner.

Step 1 image

2. Click Settings.

Step 2 image

3. Click Billing.

Step 3 image

4. Click Codes.

Step 4 image

5. Next, let's update our coding system for the institutional level of care. Click CCode under the Coding System drop-down.

Step 5 image

6. Select RCode.

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7. Click Add item.

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8. Click Code and we'll enter our RCode.

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9. Click Description and we'll complete it for you.

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10. From the Effective Date field, choose 1.

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11. Click Submit.

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12. Next, let's update the Coding System again. Click RCode.

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13. Select HCode.

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14. Click Add item.

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15. Click on the Code field and we'll enter it for you.

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16. Click on the Description field and we'll add it for you.

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17. Next, click on the Effective Date field.

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18. Click 1.

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19. Click Submit.

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20. Now that we've built out our codes, let's create the Level of Care. Click Patients.

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21. Scroll down to the Levels of Care section. Click Add item to add a new Level of Care.

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22. Click Level of Care Name field and we'll add the name.

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23. Click the Billable checkbox.

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24. Next, click on the LOC Type drop-down.

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25. Select Attendance Based (PHP/IOP).

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26. Next, check the Sun checkbox and we'll check the rest for you.

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27. Click on the HCode drop-down.

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28. Select the S0201 code we previously built.

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29. Next, click on the RCode drop-down.

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30. Select 0913.

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31. Click into the Hours field and we'll add the minimum hours required to bill this service.

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32. Place of service is required for Professional Claims and is not required for Institutional.

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33. Next, click on the Claim format drop-down.

Step 33 image

34. Select Institutional.

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35. Click Type of bill field and we'll complete it for you.

Step 35 image

36. Click Locations.

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37. Choose the locations that will use this service. Click Alhambra Recovery.

Step 37 image

38. Click Coral Gables Programs.

Step 38 image

39. Click Locations to close.

Step 39 image

40. Click Update to save.

Step 40 image

41. Next, we'll open AveaOffice to add the matching level of care service. Click Admin.

Step 41 image

42. Click Practice Admin.

Step 42 image

43. Click Services.

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44. Click Create Service.

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45. Click into the Name field and we'll complete it for you.

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46. Next, click to complete the Service Description on Patient Statement field. This field is only available for organizations who have purchased Patient Billing.

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47. Click on the Level of Care drop-down.

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48. Select PHP.

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49. Click the Attendance Calendar - Requires Utilization Plan or Service rate toggle.

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50. Click on the Kipu Level of Care Service drop-down.

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51. Select PHP to map the EMR Level of Care we created to this Avea Service.

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52. Click CREATE.

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53. Next, we need to add the Billing Service Profile. Click PHP.

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54. Click Billing Profiles.

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55. Click Create Service Billing Profile.

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56. Click into the Profile Name field and we'll complete it for you.

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57. Click Claim Form Service Name field and we'll complete it for you.

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58. Click to toggle on the Require Preferred Claim Type field.

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59. Click on Institutional Revenue Code to add in the RCode the field.

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60. Click on Institutional HCPCS/CPT Code to add the HCode.

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61. Click on the Institutional Bill Type Prefix to add in the type of bill.

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62. Professional Place of Service isn't needed for Institutional claims.

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63. Click on the Allow Multiple Services Per Claim toggle.

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64. Click on the Itemize 837I Claims toggle to allow itemization for these services.

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65. Click CREATE.

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66. Next, let's add our Facility rates. Click Admin.

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67. Click Practice Admin.

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68. Click Facilities.

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69. Click Coral Gables.

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70. Click Facility Services.

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71. Click Add Service Reference.

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72. Click on the Service drop-down.

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73. Select PHP.

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74. Click on the Service Billing Profile to choose the billing profile we just created.

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75. Select All Payers.

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76. Click into the Unit Rate field and we'll complete the rate for you.

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77. Click ADD.

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78. That's it for creating Level of Care services in the EMR and Avea.

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** Best experienced in Full Screen (click the icon in the top right corner before you begin) **

https://www.iorad.com/player/2206302/Creating-Level-of-Care-Services--Avea-Integration-?iframeHash=trysteps-1

1. Create Billing Codes

In this example, we'll show how to create a new PHP Level of Care that we intend to bill institutionally with codes 0913 and S0201. 

The first step is to set up the EMR codes we want to include in the Level of Care. The Kipu EMR supports three types of codes: 

  • CCodes for professional claims
  • RCodes (required to bill) and HCodes (optional) for institutional claims 
Because we are creating a level of care that will bill on an institutional claim form, we'll create the 0913 as a Revenue Code (RCode) and S0201 as an HCPCS Code (HCode). 

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

2. Build the Level of Care

Next, 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 entered in the desired Place of Service, Claim Format, and Type of Bill. It's important that these details match between systems to ensure the service transmits from the Billing Report successfully.

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

3. Create the RCM UR-Required Service

Next, build the Service in the RCM Practice Admin under the Services tab. 

When creating the service, it's important to:

  1. Select the correct Level of Care from the drop-down for reporting purposes.
  2. Toggling on the Attendance Calendar - Requires Utilization Plan or Service Rate setting. This requires the patient to have a UR plan for this level of care before it can be billed. 
  3. 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

Next, create the Service Billing Profile for the service to set the billing standards. 

When building the Service Billing Profile:

  1. Set the Claim Type to the Claim Format set in the EMR Level of Care (e.g., match institutional to institutional).  
  2. We recommend toggling on the Require Preferred Claim Type setting. 
  3. Enter the Institutional Revenue code, this should match the RCode added to the EMR Level of Care. 
  4. If used, enter the Institutional HCPCS/CPT code, this should match the HCode added to the EMR Level of Care. 
  5. Set the Institutional Bill Type Prefix, this should match the Type of Bill field in the EMR Level of Care. 

*When building a Professional Service Billing Profile be sure to select the same Professional Place of Service field on the Service in the RCM and on the EMR Level of Care. Additionally, please follow the instructions for setting up Professional Services to add the HCPCS/CPT Code which should match the CCode in the EMR Level of Care. 

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

5. Add Facility Service Reference

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

When adding a facility rate, select the correct Service and related Billing Profile. For Professional Services, you'll have another line to add in the Professional Unit Rate in addition to the institutional/Patient Billing Unit Rate. 

Click here for step-by-step instructions for setting Facility Rates. 

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