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 ancillary workflow is covered in the article found here.
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 the Level of Care per-diem rate, only check the Billable box on the Evaluation and Group Sessions. Let’s review what this looks like in the Kipu EMR.
Billable 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.
- Open Templates and click on the Evaluations tab.
- Any Evaluation marked as Billable has been configured and is ready to bill.
- To make an evaluation billable, open the evaluation by clicking on the title.
- In the evaluation, check the Billable box.
- When you check the Billable box, a pop-up appears if the form does not already contain the field for start and end date/time. Clicking OK will automatically add the start and end date/time field, allowing duration to be calculated for the evaluation. Refresh the page to view these new fields (optional).
- Checking Billable creates additional fields. The majority of these fields will only be used when configuring an evaluation that will be billed as ancillary. Click here for information on billable ancillary evaluations.
- When the form is only marked as Billable, the billing code assigned to the patient’s Level of Care will be billed when this form is added to the patient chart and completed if:
- The code is assigned to the Level of Care under Settings > Patients.
- The LOC is assigned to the patient by adding a concurrent review to their facesheet.
- The Place of Service indicated in the LOC (if the claim format is professional) will also be used and appear on the billing report.
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If the selected LOC is outpatient, the claim will use the code and claim format entered in the group or evaluation template.
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Coding System: Required if the Ancillary box is checked, optional otherwise. 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.
- Claim Format: Select Professional or Institutional.
- Click Update to save your changes.
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.
- Open Templates and click on the Group Sessions tab.
- To create a new Group Session, click + New Group Session and follow these instructions.
- To make an existing Group Session billable, click on the edit icon.
- Check the Billable box. If this group session is marked Billable and Ancillary is not checked, the system will bill the code related to the patient’s Level of Care. You can review the codes associated with the Level of Care under Settings> Patients.
- Checking Billable creates additional fields. The majority of these fields will only be used when configuring a Group Session that will be billed as ancillary. Click here for information on billable ancillary group sessions.
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Coding System: Only required if the Ancillary box is checked. Click here for more information about billable ancillary group sessions.
- HCode: Any code used for Institutional claims
- CCode: Any code used on Professional claims
- RCode: Revenue Codes, used for Institutional claims only
- Claim Format: Select Professional or Institutional.
- Click on the Update button to save your changes.
Note about Group Sessions:
Using the Add Group Signer button and configuring the Group Session template to use "Last signer" will not pull the newly added Group Signer in as the Billing Provider. The Billing Provider field will be blank and can be manually selected.
How Do Evaluations/Group Session System Rules Work?
- If an Evaluation/Session is marked billable, it will pull the code based on the Level of Care.
- Place of Service will be respected for Professional Claims only.
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