Creating Ancillary Services [Authorization Required] for the RCM Integration

When creating a new ancillary service, a few crucial steps must be completed for the services to map properly across the systems. This article will focus on creating an ancillary service requiring authorization. For instructions on creating ancillary services that don't require authorization, click here. 

Required Permissions

To complete the following steps, users must be super admins in the EMR and, at minimum, practice admins in the RCM. For more information on user permissions in the RCM, click here. 

Process Overview

Creating authorization-required ancillary services for the integration is a five-step process that requires correct execution to ensure billable charges are transmitted accurately.

In the EMR

The first two steps of the process start in the EMR: create the code and build the service. Let's review that process together! 

1. Create the Code

The EMR supports three types of codes:

• CCodes for professional claims
• RCodes (required to bill)
• HCodes (optional) for institutional claims 

In this example, we'll show how to create a new ancillary service for Individual Therapy - 60 minutes that we intend to bill professionally with code 90837.

• Because we are creating a service that will bill on a professional claim form, we'll make the 90837 a CCode.
• The description name should always match the service name in the RCM. When transmitting the charge to the RCM, the system must match the description name to the service name and the CCode to the CPT Code set in the billing profile to successfully transmit the charge. Please note that neither field accepts parentheses.
  
• Include the effective date in the corresponding field and click Submit to finish.

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

2. Build the Service

A new service for Individual Therapy - 60 Minutes will be created. Services are configured under Settings > Billing Audit Tool> Services. Ensure the Service Name field matches the code's description and select the corresponding code in the CCode field.

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

In the RCM

Ancillary services in the Kipu EMR are called standalone services in the Kipu RCM (Avea). Let's review the last steps of the process together. 

3. Create the Standalone Service in the RCM

Build the service in the RCM Practice Admin under the Services tab. 

When creating the service, it's important to: Select the Ancillary from the Level of Care drop-down for reporting purposes. Leave the Attendance Calendar - Requires Utilization Plan or Service Rate setting toggled off. Select the correct Kipu standalone service from the drop-down. This list contains the services configured in the Kipu EMR under Settings > Billing Audit Tool > Services.

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

4. Create the Service Billing Profile

Create the service billing profile for the service to set the billing standards. 

When building the service billing profile: Set the Preferred Claim Type to the claim format set in the EMR Service(e.g., match professional to professional, etc.).   We recommend toggling on the Require Preferred Claim Type option.  Enter the institutional revenue code, even for professional claims. You can use a placeholder if needed.  Set the Institutional Bill Type Prefix, even for professional claims. You can use a placeholder if needed. When building a professional service billing profile be sure to select the same Professional Place of Service field option on both the EMR and RCM services. Set the HCPCS Unit Measurement Basis field to Units for anything that isn't per-diem billing.

Additionally, please follow the instructions for setting up professional services to add the HCPCS/CPT code, which should match the CCode in the EMR service.

Click here for step-by-step instructions for building service billing profiles. 

5. Add Facility Service Reference

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

When adding a facility rate: Select the correct service. Choose the related billing profile. The Institutional/Patient Billing Unit Rate field is required regardless of whether you are billing institutional or patients for this service. For professional services, you'll have another line to add the professional unit rate in addition to the Institutional/Patient Billing Unit Rate field.

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