Billing Labs

The Kipu RCM enables organizations using the Labs interface in the Kipu EMR to generate billing through the billable report. How and when these charges appear will depend on the lab type and desired workflow. Let's review these concepts together! 

Lab Types and Definitions

There are two main lab interfaces the EMR supports: Bidirectional and POC (Point-of-Collection). 

Bidirectional Interface

Bidirectional interfaces are used with labs such as Labcorp, Quest, or specialized toxicology laboratories and provide a conduit for communication between the EMR and the labs' portals. This kind of set-up is used when quantitative results of a blood draw or urine screen are required. Because outside labs often submit their own billing, this interface will need to be configured to bill by requisition. 

POC Interface

The POC interface is traditionally used by facilities that perform in-house testing and bill the payer directly for lab services. This setup is used when qualitative results from a urine screen are used to bill in-house and require less configuration than a bidirectional interface.

Configuration - Bill By Requisition

Configuring your integration for lab billing by requisition uses the same process as creating a code that requires a standalone authorization. Let's review the process together!

• The EMR supports three types of codes:

  • CCodes for professional claims
  • RCodes (required to bill)
  • HCodes (optional) for institutional claims 

  In this example, we'll show how to create a new ancillary service for Urinalysis that we intend to bill professionally with code 8001.

  • Because we are creating a service that will bill on a professional claim form, we'll make the 90837 a CCode.
  • The description name should always match the service name in the RCM. When transmitting the charge to the RCM, the system must match the description name to the service name and the CCode to the CPT Code set in the billing profile to successfully transmit the charge. Please note that neither field accepts parentheses.
    
  • Enter the effective date in the corresponding field, then click Submit to finish.

  Click here for step-by-step instructions on creating codes. 

• A new service for Urianlysis will be created. Services are configured under Settings > Billing Audit Tool> Services. Ensure the Service Name field matches the code's description, set the Classification to POC Lab, and select the corresponding code in the CCode field.

  Click here for step-by-step instructions on creating services. 

• When creating the service in the RCM, the service name must match the code description in the EMR. Additionally, the Kipu Standalone Service dropdown must be mapped to the service configured in the EMR.
   

  Click here for a step-by-step on creating services in the RCM. 

• To ensure the codes are transmitted accurately and to the correct claim form, a professional service line reference must be entered directly in the billing profile.

  Click here for step-by-step instructions on configuring billing profiles in the RCM.

• The final step in configuring the service will be to establish a rate within the facility. Though the claim will be billed on a professional form, you will be required to enter a rate for both institutional and professional claims.
  

  Click here for a step-by-step on creating facility rates in the RCM. 

Configuration - Bill By Result

Configuring your integration for lab billing by result uses the same process as creating a code for an ancillary charge. Let's review the process together!

• The EMR supports three types of codes:

  • CCodes for professional claims
  • RCodes (required to bill)
  • HCodes (optional) for institutional claims 

  In this example, we'll show how to create a new ancillary service for Urinalysis that we intend to bill professionally with code 80001.

  • Because we are creating a service that will bill on a professional claim form, we'll make the 80001 a CCode.
  • The description name should always match the service name in the RCM. When transmitting the charge to the RCM, the system must match the description name to the service name and the CCode to the CPT Code set in the billing profile to successfully transmit the charge. Please note that neither field accepts parentheses.
    
  • Enter the effective date in the corresponding field, then click Submit to finish.

  Click here for step-by-step instructions on creating codes.

• Once you have created the code and built the service (when applicable), the next step is to configure the lab settings to map the correct code. In this example, you can see we selected the Lab, matched the Panel Description to the code description, and selected our CCode of 80001.
  

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  Please ensure the Panel Code field matches the panel codes in the results to generate billable items properly.
  

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  Additionally, lab settings can be configured to Bill By Analyte (Acolyte) by clicking the toggle. This setting instructs the system to generate charges based on the individual test codes provided by the lab.
  

  Click here for step-by-step instructions on configuring lab settings.

• When creating the service in the RCM, the service name must match the code description and panel description in the EMR. Additionally, the Kipu Standalone Service dropdown must be mapped to the service configured in the EMR. 

  Click here for a step-by-step on creating services in the RCM. 

• To ensure the codes are transmitted accurately and to the correct claim form, a professional service line reference must be entered directly in the billing profile.

  Click here for step-by-step instructions on configuring billing profiles in the RCM. 

• The final step in configuring the service will be to establish a rate within the facility. Though the claim will be billed on a professional form, you will be required to enter a rate for both institutional and professional claims.
  

  Click here for a step-by-step on creating facility rates in the RCM. 

Generating Charges - Bill By Requisition

Generating charges for labs follows the same workflow as traditional charges, but with a minor nuance. To ensure success, users will need to:

• Before generating charges from lab requisites, please ensure the payer's address and phone number are on the patient's facesheet in addition to the Plan Type. This information can be added in one of two ways: directly in the payer profile or in the patient's insurance set.
  
• Please note that this step is only required when a service has been built for the code in the EMR. If this is being billed as ancillary, an authorization is not required.
  
  A standalone authorization must be created for the patient to ensure the charge is transmitted properly. Click here to learn more about creating a standalone authorization using the integration.
• Once the patient's chart has been configured, the next step is to generate a lab order. Click here for more information on generating lab orders in the EMR.

• Creating a requisition is an important step in the process since it instructs the system on how and when to generate a charge from a lab and what information to include.
  
  To ensure a billable charge is generated from a requisition, at least one Point of Care question must be present and answered. If you are missing this question, please reach out to [e-mail] for further assistance.
  

  Click here for more information on creating a requisition in the EMR.

• Once the specimen has been collected, the lab requisition is complete and will generate a charge visible on the billable report. After confirming the billing information is correct, the charge is ready to be transmitted. For more information on the billable report, click here.
• When a charge is successfully transmitted via the billable report, it will appear in the RCM's Attendance Calendar, awaiting submission to the Work Center. To learn how to submit attendance to the Work Center, click here.
• .After the attendance has been submitted, the charges from the EMR are then converted to new claims. Click here to learn more about creating and submitting claims.

Generating Charges - Bill By Result

Generating charges for labs follows the same workflow as traditional charges, but with a minor nuance. To ensure success, users will need to:

• Before generating charges from lab results, please ensure the payer's address and phone number are on the patient's facesheet in addition to the Plan Type. This information can be added in one of two ways: directly in the payer profile or in the patient's insurance set.
  
• Once the specimen has been collected, tested, and the results have been received, a charge will be generated on the billable report. After confirming the billing information is correct, the charge is ready to be transmitted. For more information on the billable report, click here.
• When a charge is successfully transmitted via the billable report, it will appear in the RCM's Attendance Calendar, awaiting submission to the Work Center. To learn how to submit attendance to the Work Center, click here.
• .After the attendance has been submitted, the charges from the EMR are then converted to new claims. Click here to learn more about creating and submitting claims.