Creating Ancillary Services [Authorization Required] (RCM Integration)

Ancillary services in the Kipu EMR are referred to as Standalone Services in the Kipu RCM (Avea). When creating a new Ancillary service, there are a few crucial steps that need to be completed in order for the services to map properly across the systems. In this article, we'll focus on how to create an Ancillary Service that requires an authorization to be attached to the claim form. For instructions on creating ancillary services that don't require authorization, click here. 

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 Service in the EMR
3. Create the matching Standalone Service in the RCM
4. Set up the associated Billing Service Profile in the RCM
5. Add the Service Facility Reference in the RCM

1. Create Billing Codes

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. 

The first step is to set up the EMR code we want to bill for the Service. 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 service that will bill on a professional claim form, we'll create the 90837 as a CCode. Please do not use parenthesis in the description to prevent errors in matching the codes between the systems.

 

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

2. Build the Service

Next, create a new Service for the Individual Therapy 60 minutes service. Services are configured under Settings > Billing > Services.

You'll notice that we selected the CCode we previously built and chose the desired Claim Format. 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 Services. 

3. Create the Standalone Service in the RCM

Next, 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 > Services.

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: Set the Claim Type to the Claim Format set in the EMR Service(e.g., match professional to professional).   We recommend toggling on the Require Preferred Claim Type setting.  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 on the Service in the RCM and on the EMR Service. Set the HCPCS Unit Measurement Basis 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 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. Choose the related Billing Profile. An Institutional/Patient Billing Unit Rate is required regardless of whether you are billing institutional or patients for this service. 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.