Payer Rules: Admit to Discharge Billing Rule

The Payer Rules tab allows users to create billing rules specific to each insurance. This article is focused on building an admit-to-discharge bundling rule, which will bundle all per-diem (in-patient, attendance based, or per diem service) charges for the patient's treatment episode into a single row on the billing report. Before you can add an admit-to-discharge bundling rule, you must first create the payer rule. Click here for instructions on creating the payer rule.

Building an Admit to Discharge Billing Rule

Once you have your payer rule parameters created, the next step is to create the Admit to Discharge payer rule. Please note that this rule only applies to levels of care configured as Inpatient, Attendance Based, and Per Diem Service billing types.

1. Click Add Billing Rule.
2. Choose Admit to Discharge from the Billing Rule Type drop-down.
3. Next, search for the codes that should be bundled. You can select one or multiple codes (you can bundle codes related to different levels of service if needed).  
4. Once a code is selected, the Do Not Generate Until Discharged and Combine Days checkboxes will appear. You will not be able to edit the Date of Service field.
   1. Do Not Generate Until Discharged: If you check off this box, you will not see billable items associated with the code (or codes) entered until the patient is discharged. If it is not selected, then the codes will appear immediately.
   2. Combine Days: Check the Combine Days box if you would like to combine multiple per-diem days into a single per-diem row on the billing audit tool report (e.g., if you combine dates of service 8/1, 8/2, and 8/3, this would appear as a single row with a single unit on the report with a date of service of 8/1). Selecting Combine Days will cause the Aggregate Units checkbox and Through Date dropdown to appear.
   1. Aggregate Units: Checking this box will automatically add the units for each of the combined per-diem days (e.g., if you combine dates of service 8/1, 8/2, and 8/3, this would appear as a single row on the billing audit tool report with 3 units and a date of service as 8/1).
   2. Through Date: This drop-down defaults to Last Service Date, but you can select Discharge Date if needed. 

Expected Billing Audit Tool Report Behavior

For Inpatient, Attendance-Based, and Per Diem Service Levels of Care with codes matching the payer rule:

• When Combined Days is selected, the matching billable item rows will be combined into a single item on the Billable Items tab.
  • All documents (evaluations and group sessions) for all matching per-diem items will appear in the new single per-diem row.
  • The Date of Service will automatically be set to the first per-diem date of service.
• When Combined Days and Aggregate Units are selected, the matching billable item rows will be combined into a single item on the Billable Items tab.
  • All documents (evaluations and group sessions) for all matching per-diem items will appear in the new single per-diem row.
  • The Date of Service will automatically be set to the first per-diem date of service.
  • The number of units for each per-diem day will be added together. If 8/1 and 8/2 are bundled together, you would have 2 units listed.
• The admit to discharge bundling also works together with patient levels of care that do not require documentation.
• The admit to discharge bundling will not include items that occur after discharge.

Edit an Existing Payer Rule

To edit an existing payer rule, either click on the payer rule name or on the pencil icon.