Creating Ancillary Services for RCM (Avea) 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 will not require an authorization. For instructions on creating ancillary services that may require an authorization number to be written to the claim, click here. 

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

At a high level, this process includes: 

1. Creating Codes in the EMR
2. Create the Standalone Service in the RCM
3. Set up the associated Billing Service Profile in RCM
4. Add the Service Facility Reference in RCM

1. Create Billing Codes

In this example, we'll show how to create a new Ancillary Service for Outpatient Office Visits that we intend to bill institutionally with codes 0914 and 99205. 

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 an institutional claim form, we'll create the 0914 as an RCode. Please note that the RCM will attempt to match the EMR Service to the RCM Service using the Code Description field in the EMR first, so please ensure that Code Description in the EMR matches the Service Name in the RCM exactly. 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. Create the RCM Standalone Service

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

When creating the service, it's important to: Ensure the Name field matches the EMR Code Description field exactly. 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. Do not select a Service from the Kipu Standalone Service drop-down.

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

3. 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 desired Claim Format We recommend toggling on the Require Preferred Claim Type setting.  Enter the Institutional Revenue code, You can use a placeholder if needed.  You can include an Institutional HCPCS/CPT Code as 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.

If creating a Professional service, 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. 

4. 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.