Creating Ancillary Services 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. In this article, we'll focus on creating an Ancillary Service that will not require authorization. For information on creating ancillary services requiring an authorization number, 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 an ancillary service for the integration is a four-step process that requires correct execution to ensure billable charges are transmitted accurately.

In the EMR

The first step of the process is creating the code in the EMR. Let's review that process together! 

1. Create the Code

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 

In this example, we'll show how to create a new ancillary service for Group Therapy that we intend to bill professionally with code 90853. 

• Because we are creating a service that will bill on a professional claim form, we'll make the 90853 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. 
  
• Add the Effective Date of the code before clicking Submit.
  
   

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

In the RCM

Ancillary services in the EMR are called standalone services in the RCM. Let's review how to create a standalone service in the RCM! 

2. Create the 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 Preferred Claim Type to the desired claim format, in this example, Professional.  We recommend toggling on the Require Preferred Claim Type setting.  For Institutional claims, enter the Revenue Code.  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, match the same Professional Place of Service field on the Service in the RCM as it appears in the EMR Service. Set the HCPCS Unit Measurement Basis to Units for anything that isn't per-diem billing.

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 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 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 on setting facility rates.