Billing Audit Tool Report: Send Billable Items (Integrated Billing)

You can send billable items from the Kipu EMR to Kipu RCM, CMD, or through HL7 using the billing audit tool report (all locations or location-specific). The billing audit tool report is also available from the patient’s chart if you prefer to bill by patient.

Important: There is a delay between when the charge is created and when it appears on the billing audit tool report (typically around 5-15 minutes). 

Billing Audit Tool Report

Let's review how to bill from the billing audit tool report. The billing audit tool report pulls all billable items created in the Kipu EMR and allows you to select which items you would like to send to for billing. 

1. Navigate to the Reports tab and select Billing Audit Tool.
2. At a minimum, enter the start and end date range and click Search.
   • Start Date: This is the date when the evaluation was started by the Provider (this may not be the date of service). To account for this timing, we recommend running this report once a month for the previous month to ensure all billable items have been sent to the RCM. 
3. All unbilled items appear in a list view.
   1. Name: The name of their patient followed by their MR number. You can use the filter field under Name to search by patient name or by their MR number.
   2. Date: The date the evaluation or group session was started.
   3. Admit Date: The date the patient was admitted. 
   4. Discharge Date: This is the date the patient was discharged. Kipu will not stop you from billing services on the date of discharge, however, the system will give you a soft warning (yellow circle) stating the service is on the Date of Discharge. If you click on the checkbox below Discharge Date, you can choose to view discharged or non-discharged patients.
   5. Location: The location where the patient was treated.
   6. Insurance: The patient’s insurance company who will be billed for this service. 
   7. LOC: The patient’s level of care as established in their Utilization Plan or Clinical Level of Care. This field will be blank for ancillary billable items.
   8. Codes: The code(s) being billed.
   9. Units: The number of units being billed.
   10. Claim Format: Institutional or Professional. 
   11. Billing Provider: If this field is blank, the default billing rendering provider set up in the Konnector will be billed on the claim. Otherwise, the name of the provider on the patient's UR plan (per-diem services) or selected within the Evaluation or Group Session (ancillary services) will appear here and will be billed as the rendering provider. Additionally, you can manually choose a different Billing Provider for the claim, if needed.
4. Click on the Hx icon to view the Payer Rule History, including the name of the payer rule applied, link to the payer rule applied, and the original code(s), claim format, place of service, and units (if modified by the payer rule).
   • Note: This button only displays if the charge was modified by one of the following payer rules: Replace Code/Claim Format, Replace POS, Unit Billing, or Add Modifier.
5. Click on the Edit icon to make minor updates to the charge lines like including or excluding Codes (ancillary billable items with multiple codes available only), adding a Modifier, Billing Provider, or Place of Service. You can make these updates in bulk e.g., if you updated the diagnosis code order, you can apply these updates to all similar billable items for the same patient in the batch. Additionally, you can set this as the default for all future billable items of this type for the patient using the checkboxes in the Edit Claim window.
   
   • Note: You can update the claim format here, however, the default codec set available (C Codes for Professional and H/R Codes for Institutional) won't change and will still display the code set for the original claim format. If you choose to transmit the billable items with the updated claim format, you may need to change the codes in your billing software. 
   • When you send diagnosis codes, you can only send up to 18 diagnosis codes at a time. If your patient has more than 18 diagnosis codes, only the first 18 will be sent. Additionally, HL7 transmissions for DG1 segments will treat the date the diagnosis code was added as the start date using the manage diagnosis codes evaluation workflow.
6. To remove diagnosis codes from the claim, click the x. To add excluded diagnosis codes, click the +. The changes made here will be reflected on the patient's chart under Billing > Diagnosis Codes.
7. Click on the + to view additional information about this charge.
8. You can see insurance plan information, diagnosis codes, level of care, and whether the charge was added through an evaluation or group session. When billing per diam for Level of Care, billable items on the same day will group together under the same charge line with their associated durations.
   • Both evaluations and group sessions are viewable by clicking on the hyperlinked title. Additionally, expanded group sessions will display the name of the session leader rather than the provider in the Group Sessions section.
9. The system has a few built-in alerts. Red alerts mean that you cannot bill that charge until the alert issue is resolved. Yellow alerts are a warning and will not prevent billing. Click here for common errors and resolutions.
10. Use the Select checkboxes for items that you want to bill or use Select All to choose all items that can be billed on that page (items with red alerts won’t be selected).
11. You can also use the Don’t Bill checkbox to move items to the Do Not Bill tab on the billing audit tool report. You will be asked to include a Do Not Bill Reason if enabled.
12. Once you have made your selections, click Transmit at the bottom of the report.

Post Transmission

1. Following transmission, you will be directed to the Batches tab. Here will you see your batch listed as Pending.
2. Refresh the page to confirm the Transmitted column has been updated to Yes and click on the View button to review the billable items. You must review every batch submitted. Just because the batch was successfully transmitted does not mean that all items within the batch were successfully sent.
3. Claims that were successfully transmitted will have a Claim ID.

Errors

1. If there is an error message instead of the Claim ID, the charge was not sent to the integrated billing system. The best option here is to use the red X to delete the individual charge, fix the issue, and then re-bill. Click here for a list of post-transmission errors and how to resolve them.
2. If there is an error without a delete button, you have a few options. With any of the options below, we recommend downloading the original batch details to an Excel or CSV file to create a worklist. Options include:
   • Delete the entire batch, manually remove the claims that were successfully transmitted to the billing system to prevent duplicates, and rebill from the billing audit tool report.
   • Delete items in a specific batch by either clicking the red x (to delete individual items) or by clicking the Remove Errors button to delete all items with errors.
   • Delete the entire batch and manually mark the successfully transmitted claims as Do Not Bill in Kipu EMR with the Do Not Bill Reason of Already Billed. Then rebill the other billable items.
   • Manually bill the errored charge(s) directly from your integrated billing solution.

Note: Batch Transmission Errors notifications can be set up under Settings > Notifications if you would like certain users or users with certain roles to receive notifications when completed batches have items in the Pending or Error statuses.

Download HL7 Error Behavior 

If your instance uses the Download HL7 option, batches that have errors can only be viewed, not downloaded.

However, if you remove the item with the error (or resolve said error), the Download HL7 button will reappear.

Move From Do Not Bill to Bill

You can move an item previously marked Do Not Bill back to the Billing tab for transmission to your integrated billing system.

1. From Billing Audit Tool, click on the Do Not Bill tab.
2. Enter your date range and click Search.
3. Check the box and click Remove Do Not Bill to send the charge back to the Billing report.

Patient Chart

You can bill for an individual patient directly from their patient chart. 

1. Click on the Billing tab in the patient chart. Because these tabs can be renamed, your tab may named something else like Patient Ledger, Billing Report, etc.
2. This tab contains Billing Items, which mirrors the Billing Audit Tool tab but only shows billable items for the specific patient.
3. Bill out billable items (or move billable items to Do not Bill) from the Billable report. 
4. When editing a charge, you can make these updates in bulk e.g., if you updated the diagnosis code order, you can apply these updates to all similar billable items in the batch. Additionally, you can set this as the default for all future billable items of this type for the patient using the checkboxes in the Edit Claim window.
   
5. Use the Select checkboxes or Select All button to choose which items to bill. Anything with a red alert cannot be selected. Click here to learn more about resolving errors.
6. Select the Don’t Bill checkbox for anything you don’t want to send to your integrated billing solution. If you have configured Do Not Bill Reasons in your Patient Settings, select the appropriate reason.
7. Click Transmit to bill. You will be automatically directed to the Billed Items tab.
8. You will be automatically directed to the Billed Items tab. Each transmitted charge appears on this tab as Pending.
9. Refresh the page. You will see the status of the claim in the Claim ID field.
10. Each billable item with a Claim ID has been successfully sent to your integrated billing system.
11. Any items with an error message instead of an ID failed and will need to be deleted and rebilled. Click here for a list of transmission errors and how to resolve them.
12. Click on the error message to open the batch.
    
13. Use the Delete (x) button to send the charge back to the Billable tab.
14. If there is an error without a delete button, you have a few options. With any of the options below, we recommend downloading the original batch details to an Excel or CSV file to create a worklist. Options include: 
    • Manually bill the errored charge(s) directly from the integrated billing system.
    • Delete the entire batch and manually mark the successfully transmitted claims as Do Not Bill in Kipu EMR with the Do Not Bill Reason of Already Billed. Then rebill the other items.
    • Delete the entire batch, manually remove the claims that were successfully transmitted to the billing software (within the system) to prevent duplicates, and rebill from the Billing Report. 
15. Do Not Bill Items: From this tab, you can review the list of billable items marked as Do Not Bill and their reasons (if selected). You can move items from this tab back to Billable Items if needed by selecting the Charge and clicking Remove Do Not Bill.
16. Diagnosis Codes: This tab allows you to set the default billing order for the patient’s diagnosis codes. This is the order that will appear on the claim, and if you need to modify the order to maximize claim payments, use the arrows. Do keep in mind, however, that you cannot remove a diagnosis code from claims here. If you do need to remove a code, you can remove it from the specific charge by editing the charge under Billable Items.
17. Ledger: This tab allows you to manage patient payments.

Delete a Batch

Follow these steps below to delete a batch.

Charge Information Transmitted to the Billing System

• When billable items are sent to the RCM, the billing audit tool report information is used to match the items between the two systems. Check out the Kipu EMR + Kipu RCM Integration Tables article for more information. 
• When billable items are sent to CMD, the billing audit tool report information is used to match the items between the two systems. Check out the Kipu EMR + CMD Integration Tables article for more information.