The billable outpatient workflow allows facilities to bill outpatient levels of care without maintaining duplicate documentation, reducing confusion and enforcing consistent behavior.
Review Levels of Care Settings
For more detailed information about Level of Care Settings, check out this article.
Permissions: Only users with the Super Admin role can complete this step. If you do not have the Super Admin Role, please work with a user in your facility who does.
- Navigate to Settings > Patients (depending on your facility's settings, this tab may be called Clients or something else), navigate to the Levels of Care section, and review any levels of care with the LOC type Outpatient selected.
- If the Billable checkbox is enabled, billable, non-ancillary evaluations and group sessions will generate individual billable items using the codes and claim formats from their corresponding evaluations/group session template.
- Note: Any codes, claim formats, and other selections currently in Level of Care Settings won't apply to the billable items, however, if information has already been entered, it won't be removed.
- If the Billable checkbox is not enabled, individual billable items will generate, but will not apply any codes or claim formats.
- If the LOC type is incorrect and you want to generate a per diem billable item instead of individual items, complete the following steps.
- Update the LOC type to Inpatient or Attendance Based.
- Ensure that the Billable checkbox is enabled and that you select codes, claim format, and other items as needed.
- If you do not have any levels of care with LOC Type Outpatient selected, create one (or more) as needed.
- Scroll to the bottom of the section and click Update to save your changes.
Note: Billable and Ancillary evaluations and group sessions will continue to generate individual billable items as normal.
Prepare Billable Evaluation/Group Session Templates
Check out this article for detailed instructions on creating/editing billable evaluations and group session templates.
Permissions: Only users with the Super Admin or Manage Templates roles can complete this step. If you do not have these roles, please work with a user in your facility who does.
- Find the Billable group session or evaluation template(s) you want to generate individual billable items for patients with billable, outpatient level of care types.
- If the template is Billable Only, add the code(s) and claim format
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Group Sessions:
- Evaluations:
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Group Sessions:
- If the template is Billable and Ancillary, no further action is needed. This template is already generating individual billable items for all level of care types.
Using Outpatient Billable Evaluations and Group Sessions
Once you have created the desired evaluation or group session templates, they work like regular templates.
However, do keep in mind that, even if the patient's insurance does not require authorization, you must use an authorization to assign a UR level of care so that the system knows that the patient is receiving a billable, outpatient level of care and can trigger the correct codes (you can do so without entering an authorization number). Check out this article for instructions on adding an authorization.
- An outpatient billable evaluation will appear as follows once the billing item is submitted.
- An outpatient billable group session will look like this.
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