Let’s review how to ensure that Evaluations and Group sessions are billable. Important: Billable items can be reported with Financial Reports. Lab specimens processed through a Lab interface are considered billable items as well.
There are two ways to bill out from Kipu EMR: Level of Care (per diem) and Ancillary. The billable workflow is covered in this article.
Level of Care vs. Ancillary Billing
Levels of Care are typically billed at a per-diem rate. Meaning that while the patient usually has more than one service in a day, the services will be bundled and paid at a daily rate rather than by individual service. Any additional treatment or non-covered activities that are not included in the per-diem rate would need to be billed separately as ancillary items.
To create a billable item for an Ancillary rate, check the Billable box, the Ancillary box, and enter the code(s) that should be billed. Let’s review what this looks like in the Kipu EMR.
Billable Ancillary Evaluations
To create Evaluation forms that can be billed, the documents must be marked as billable. Review the following instructions for configuring billable evaluations within the Templates section. Follow the steps for creating a billable evaluation found here up through step six.
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Ancillary: Check this box to create an individual charge—separate from all other services rendered for the patient—that does not relate to the per diem level of care services. Marking the form as billable and ancillary will bill the code added to the Codes box(es).
- Ancillary/Billable: When the form is marked as Billable and Ancillary, and a code is entered in the Codes section, the form will trigger a billable charge with the code added to the box.
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Display Place of Service: The place of service drop-down on ancillary billable forms can be hidden if needed.
- The first option on the drop-down will be the default chosen for the instance. If a different setting was not specified when your instance was set up by a Kipu staff member, this dropdown will default to Edit and View Modes. If you need to make changes to your instance's settings, please contact support.
- Hide: If the template is set to Hide, then the Place of Service drop-down won't appear on the Evaluation form.
- Edit Mode: If the template is set to Edit Mode, then the Place of Service drop-down will appear when the Evaluation is being edited, but will be hidden from the view mode.
- Edit and View Modes: If the template is set to Edit and View Modes, then the Place of Service drop-down appears in both view and edit modes.
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Place of Service: When the Ancillary box is checked, you can select a place of service from the drop-down. The place of service can be adjusted by the provider when the evaluation is being documented or from the Billing report, as needed.
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Konnector: Ancillary evaluation templates can be configured with a default ancillary Konnector to automate the biller's workflow if there is an ancillary service that always needs to be re-routed to a different destination in CMD/Avea. For instructions on setting up a konnector click here.
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Coding System: Required if the Ancillary box is checked. Begin typing the code into the field provided. If the code does not appear, you may need to add it to the Coding sections in Billing Settings. Additionally, the Coding System selected does impact which codes appear in the drop-down when searching for a code. You can enter multiple codes in each box.
- HCode: Any code used for Institutional claims.
- CCode: Any code used on Professional claims.
- RCode: Revenue codes used for Institutional claims only.
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Claim Format: Select Professional or Institutional.
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Display Billing Provider: Use this drop-down to enable a Billing Provider drop-down on the evaluation, allowing users to select the billing provider for the charges rather than using the provider set as default in the Avea or CMD Konnector (this is for ancillary services only). When checked, the provider completing the form can choose a billable provider from a drop-down. Only providers with the Billing Provider features appear in the drop-down for selection.
- Instance Setting [value]: By default, new templates will inherit the instance setting configuration for this drop-down. The value chosen in the instance setting will appear in parentheses.
- Hide: The Provider drop-down is not displayed.
- Edit Mode: The Provider drop-down will appear when editing the Group Session and Evaluation.
- Edit and View Modes: The Provider drop-down will appear when editing and viewing the Evaluation.
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Autopopulate Billing Provider: This setting determines which user is automatically chosen as the Billing Provider for Evaluations marked as billable and ancillary.
- Instance Setting [value]: By default, new templates will inherit the instance setting configuration for this drop-down. The value chosen in the instance setting will appear in parentheses.
- Konnector Billing Provider: The user who is designated as the konnector billing provider under Settings > Integrations > Konnectors. If you don't pick a billing provider on the service, and select this option, the Konnector Billing Provider will appear on the billing report.
- Form Creator: The user who adds the Evaluation will be the Billing Provider.
- Initial Signer: The first user who signs the Evaluation will be the Billing Provider.
- Last Signer: The final user who signs the Evaluation will be the Billing Provider.
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Care Team: If a care team is assigned to the patient, the system will perform the following logic check to determine the Billing Provider:
- If the primary physician has the Provider feature enabled, the system will use this individual as the Billing provider.
- If the primary physician does not have the feature enabled, the system will look at the primary therapist. If the primary therapist has the Provider feature enabled, the system will use this individual as the Billing Provider.
- If neither user is a provider, no value will be autopopulated in the field.
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Autopopulate Clinical Provider: This setting determines which user is chosen as the Clinical Provider for Evaluations marked as billable and ancillary.
- Arizona Clients Only: This setting allows you to control which provider appears on Box 19 and should only be configured for clinics with state requirements to send this information on the claim. Today, this is limited to Arizona.
- Instance Setting [value]: By default, new templates will inherit the instance setting configuration for this drop-down. The value chosen in the instance setting will appear in parentheses.
- Do Not Autopopulate: No provider will be automatically configured as the Billing provider. Users can still choose a provider from the drop-down (if configured to be visible).
- Billing Provider: This will automatically choose the user set as the Billing Provider as the Clinical Provider.
- Form Creator: The user who adds the Evaluation will be the Clinical Provider.
- Initial Signer: The first user who signs the Evaluation will be the Clinical Provider.
- Last Signer: The final user who signs the Evaluation will be the Clinical Provider.
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Care Team: If a care team is assigned to the patient, the system will perform the following logic check to determine the Clinical Provider.
- If the primary physician has the Provider feature enabled, the system will use this individual as the Clinical rendering provider.
- If the primary physician does not have the feature enabled, the system will look at the primary therapist. If the primary therapist has the Provider feature enabled, the system will use this individual as the Clinical Rendering Provider.
- If neither user is a provider, no value will be auto-populated in the field.
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Autopopulate Secondary Clinical Provider: This setting determines which user is chosen as the Secondary Clinical Provider for Evaluations marked as billable and ancillary
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Arizona Clients Only: This setting allows you to control which provider appears on Box
19 and should only be configured for clinics with state requirements to send this information on the claim. Today, this is limited to Arizona. - The options here are the same as the Clinical Provider Settings.
Billable Ancillary Group Sessions
To bill Group Sessions through Avea or CMD, the session must be marked as billable from the Template page. From the Template page, you can also set specific billing rules, such as choosing which code to bill for the Group Session, indicating a provider, and selecting a Place of Service. Follow the steps for creating a billable group session found here through step four.
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Ancillary: Check this box to create an individual charge, separate from all other services rendered for the patient that does not pertain to the per diem level of care services. Marking the group as billable and ancillary will bill the code(s) added to the Codes box and populate the claim on a Professional Claim format. The claim format can be changed on the Billing report in Kipu or in your integrated billing solution.
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Display Place of Service: The place of service dropdown on ancillary billable forms can be hidden if needed.
- The first option on the drop-down will be the default chosen for the instance. If a different setting was not specified when your instance was set up by a Kipu staff member, this dropdown will default to Edit and View Modes. If you need to make changes to your instance's settings, please contact support.
- Hide: The Place of Service drop-down won't appear on the Group Session.
- Edit Mode: The Place of Service drop-down will appear when the Group Session is being edited, but be hidden from the view mode.
- Edit and View Modes: The Place of Service drop-down appears when editing or viewing the Group Session.
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Place of Service: When the Ancillary box is checked, you can select a default place of service from the drop-down for this service. This can be adjusted by the provider when the group session is being documented or from the Billing report, as needed.
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Claim Format: Select Professional or Institutional. This field defaults to Professional.
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Coding System: Required if the Ancillary box is checked.
- HCode: Any code used for Institutional claims
- CCode: Any code used on Professional claims
- RCode: Revenue Codes, used for Institutional claims only
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Display Billing Provider: Allows you to choose when to display or not display the Billing Provider drop-down on Group Sessions.
- Instance Setting [value]: By default, new templates will inherit the instance setting configuration for this drop-down. The value chosen in the instance setting will appear in parentheses.
- Hide: The Provider drop-down is not displayed.
- Edit Mode: The Provider drop-down will appear when editing the Group Session and Evaluation.
- Edit and View Modes: The Provider drop-down will appear when editing and viewing the Group Session.
- There are three more drop-downs that allow you to be more specific about which Provider will populate on the form by default.
- Autopopulate Billing Provider: This drop-down determines which user is chosen as the Billing Provider for Group Sessions marked as billable and ancillary.
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Autopopulate Clinical Provider: This setting determines which user is chosen as the Clinical Provider for Group Sessions marked as billable and ancillary.
- Arizona Clients Only: This setting allows you to control which provider appears on Box 19 and should only be configured for clinics with state requirements to send this information on the claim. Today, this is limited to Arizona.
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Autopopulate Secondary Clinical Provider: This setting determines which user is chosen as the Secondary Clinical Provider for Group Sessions marked as billable and ancillary.
- Arizona Clients Only: This setting allows you to control which provider appears on Box 19 and should only be configured for clinics with state requirements to send this information on the claim. Today, this is limited to Arizona.
- The options here are the same as the Clinical Provider Settings.
How Do Evaluations/Group Session System Rules Work?
- If an Evaluation/Session is marked as both Billable and Ancillary, it will pull the code added to the Evaluation/Session template being used.
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