Billing Audit Tool: Lab Settings

The Lab Settings allow users to set up billing for lab result panels by mapping labs to test result codes and billing codes. You will be creating a billable item for each individual panel item. If you want to bill for lab requisitions, check out this article instead.

Required Permissions: Users must be Super Admins to set up Lab Settings. 

Setting Up Labs

Before you can configure lab settings, your instance must have lab konnectors set up, and the codes returned in lab results under Test Code. You will also need to have existing billing codes (click here for instructions).

Complete the following steps to set up billing for lab result panels!  

1. To begin, click on your initials and then click Settings. 
   
2. Then click the Billing Audit Tool tab.

3. Next, click Lab Settings.

Add New Items

3. To create a new lab setting, click the Add Item button.
4. The Add Lab Setting window appears as follows.
5. To begin, select the lab that is sending the results. The labs listed in this drop-down are the ones added as Lab konnectors. Once a lab has been associated to an item, it cannot be used again. However, you can tie as many billing codes and panel codes to an item as necessary.
    
6. Then choose the locations where the billing items are enabled. The selected locations will generate the created billing items. If a location is not selected, the billing items will not be available even if the selected lab sends data to that location.
7. Then click + Add Item.
8. You can now edit the Panel Description and other fields. You can add as many items to a lab as necessary. Keep in mind that lab results will often contain multiple panels and that each panel must be individually mapped to a billing code in order to be billed.
   1. Panel Description: Name the item for ease of identification.
   2. Panel Code: Enter the panel code. This code will be specific to the lab and the results they are returning.
      • Note: In lab results, the panel code will appear under Test Code.
   3. Billing Code: Enter the billing code that corresponds to the panel result.
   4. Action: Click the checkmark to save and the x to cancel.

9. Then choose the billing provider and referring provider. 

   

   1. You can choose Konnector Billing Provider (default) or Ordering Provider as the billing provider.
   2. You can select Ordering Provider as the referring provider or leave it blank.
10. Finally, click Submit.
11. The new item will appear in the Lab Settings list.

Edit and Delete Items

Edit Items

Once an item has been created, it can be edited as needed. 

1. To edit items, click on the edit icon.
2. In the Edit Lab Setting window, you can edit the enabled locations, the lab, and add, edit, or delete individual items. Be sure to save items as you go and click Submit when you're done.

Delete Items

To delete items click on the trash icon.

You will be prompted to confirm that you want to delete the item.

Lab Settings in Action

Once the lab settings have been created, they will appear in Labs and Billing as follows. 

1. In this Lab Settings example, the panel code is OXY, and the billing code is 4Partial.
2. When a lab result is returned from the lab and the code under Test Code is OXY, the system will apply the mapped billing code. 
   
3. Individual billing items will generate for each mapped panel. The billing code will appear at the top, and the panel code will appear in the Lab Result Panel section.

When creating billable items using Bill By Lab Results, items will be generated or not generated depending on the result status. 

Code	Name	Billable Item
A	Some Results Available	Generated
C	Correction	Generated
F	Final	Generated
I	No Results Available	Not Generated
O	Order Received	Not Generated
P	Preliminary	Generated
R	Stored	Not Generated
S	Scheduled	Not Generated
X	Order Canceled	Not Generated
Y	No Order on Record	Not Generated
Z	No Record of Patient	Not Generated