Settings: Levels of Care

Levels of Care (LOC) allow you to identify each LOC provided by your facility and how they should be billed. Levels of Care are included on the patient record when adding a utilization plan to the utilization reviews section of the patient chart or by adding a clinical level of care.

Required Permissions: Super Admins can complete the Level of Care configuration.

How Level of Care Billing Works

When billable Evaluations and/or Group Sessions are added to the patient’s chart, the codes associated with the patient's Level of Care populate on the billing audit tool report for submission to the integrated billing software. Alternatively, a Level of Care can be marked as documentation not required, and this will automatically pull the LOC charge onto the billing audit tool report each day for the patient. For in-patient levels of care with Required Documentation for Billable Day enabled, MARs or vitals can trigger a charge if no group or evaluation is documented, and if a group or evaluation is documented, it will take priority in the expanded billing view.

The system will check the Standard LOC field and LOC Type and verify that both are present and have been correctly associated. The table below indicates the Standard LOC and the corresponding LOC type. 

Standard Level of Care	LOC Type
Outpatient	Outpatient (OP)
Outpatient detoxification	Outpatient (OP)
Outpatient methadone/buprenorphine or naltrexone treatment (OTP)	Outpatient (OP)
Outpatient buprenorphine or naltrexone treatment (OBOT)	Outpatient (OP)
Intensive outpatient treatment	Attendance Based (PHP/IOP)
Partial hospitalization/day treatment	Attendance Based (PHP/IOP)
Short-term residential	Inpatient (Detox/Res)
Long-term residential	Inpatient (Detox/Res)
Residential detoxification	Inpatient (Detox/Res)
Hospital inpatient/24-hour hospital inpatient	Inpatient (Detox/Res)
Hospital inpatient detoxification	Inpatient (Detox/Res)

How LOC Charges Are Triggered 

Level of Care Type	How Changes Are Triggered
Inpatient	By documentation (if required) or automatically (if not required)
Attendance-Based	By documented group or evaluation
Outpatient	By ancillary services only

Configure Levels of Care

1. To begin, click on your initials and then click Settings. 
   
2. Then click the Patients tab. This tab is the default settings tab, and because the name can be customized, it may have a different name in your instance.

3. Scroll to the Levels of Care section. Use Ctrl + F (Windows) or Cmd + F (Mac) to search for Levels of Care on the page. 
4. Use the Add Item link to create a new Level of Care. 
   
5. Provide the Level of Care Name and choose the desired option from the Standard LOC drop-down. This field matches a location's existing, customized LOCs to standard LOCs sourced from the SAMSHA list. This step allows facilities to maintain highly individualized levels of care without sacrificing accuracy in reporting and performance. Both these fields are required.
6. For the Outpatient (OP) LOC type, if you do not check the Billable box, the patient will be billed based on ancillary service codes. No additional setup is needed for Outpatient LOCs. Please click Update to save.
7. For LOC Types Inpatient (Detox/Res) and Attendance Based (PHP/IOP), check the Billable box. Doing so enables the system to generate charges for this LOC based on documentation or system rules.
   • Attendance Based (PHP/IOP): This billing type is used for attendance-based programs where specific daily duration minimums must be met for that billable item to be considered valid. A soft warning (yellow) will appear on the billing audit tool report when the required hours aren’t met for that billable item. Additionally, if a patient is marked as absent for a group session, the corresponding billable service will not appear.
   • Inpatient (Detox/Res): This billing type is for inpatient facilities where inpatient services do not have any required minimum hours for billing. You can include hours, but it won't impact billing and will simply be visible on the billing audit tool report. Selecting this option generates two additional options within the LOC:
     • Require Documentation: If checked, documentation (e.g., groups, evaluations, MARs, vitals) must be completed for the day for a per diem charge to generate. If unchecked, charges generate automatically each authorized day as long as the patient is admitted, has an MRN, and is not marked absent. This setting applies only to Inpatient (Detox/Res) Level of Care types, and will generate at 12:00 am in the location's time zone. Click here to learn more.
     • Do Not Generate Billable Day on Discharge Date: When checked, this setting does not allow billable items to be generated on the patient’s discharge date.
8. Check the Days boxes to indicate the days per week the level of care is expected to operate. The days checked here will populate automatically in the patient record utilization review (authorization) section when a specific level of care is selected. Currently, this doesn’t impact the generation of billable items.
9. HCode, CCode, RCode: Enter the desired code for each level of care. These codes will show up on the billing audit tool report when a billable form is documented. Only active codes will be available for selection.
   • H Codes and R codes are intended for institutional payers (UB-04). You must include an R Code, H Codes are optional.
   • C codes should be set up for professional payers (CMS-1500). These will show up on the billing audit tool report when a billable form is documented.
10. Hours: Enter the number of hours per day that the facility requires for the level of care. This number is used in calculations for billable items to identify claims that have not met the required number of hours per day. Hours are primarily used for Attendance-based levels of care.
11. Place of Service: Select the Place of Service (POS) from the standardized picklist of CMS-recognized places of service, which appear on the Professional claim form. If you are creating a Level of Care for Institutional claims, the Place of Service is not supported.
12. Claim Format: Select the type of claim: Professional (uses C Codes) or Institutional (uses H and R Codes).
13. Type of Bill (Institutional Only): Enter the bill type required for institutional claims.
14. Avea (RCM) Integration: Occurrence Code, Occurrence Span Code, and Value Codes are not included in the Avea integration and should be set up using Claim Rules in the RCM. 
15. CollaborateMD/HL7 Integrations:
    1. Occurrence Code (Institutional Only): Enter an occurrence code, if required for this level of care on institutional claims. These codes can only be two digits long.
    2. Occurrence Span Code: Enter an occurrence span code, if required, for this care level on institutional claims. These codes can only be two digits long.
    3. Value Code (Institutional Only): Enter a value code, if required, for this care level on institutional claims (restricted to two characters).
    4. Value Amount: If needed, users can enter a default amount for the entered value code. This is a free-type field and you can add a monetary amount or other value as needed.
16. Autopopulate LOC Billing Provider: Choosing an option from this drop-down will cause the selected option to auto-populate. If this option is selected here and a provider is selected in the Authorization pop-up on the patient facesheet, the system will compare all completed services and automatically set the billing provider if a single provider completed all the services. If one of the following items is proceeded by Instance Setting, it means that it has been set as the default in Settings.
    1. Care Team: If a care team is assigned to the patient, the system will perform the following logic check to determine the billing provider.
       • If the primary physician has the Rendering Provider feature enabled, the system will use this individual as the billing provider.
       • If the primary physician does not have the feature enabled, the system will look at the primary therapist. If the primary therapist has the Rendering Provider feature enabled, the system will use this individual as the billing provider.
       • If neither user is a billing provider, no value will be auto-populated in the field.
    2. Konnector Billing Provider: Selecting Konnector Billing Provider from this drop-down will cause the billing provider to auto-populate if no billing provider has already been chosen.
    3. Authorization: Selecting Authorization will display a new field in the authorization window where users can choose a billing provider which will be used when the billable item generates.
    4. Same Signer: If Same Signer is chosen, all services rendered in the per diem day will be matched by provider who signed and they'll be set as the billing provider. Unsigned items will be ignored.
17. Use the Locations drop-down to select the Locations that will use the LOC.
18. Click the [drag] indicator to update the LOC positioning within the list. 
    
19. Use the X to delete a LOC.
20. Click Update to save your changes.    

Levels of Care: Common Use Case 

Payers may have different minimum hour requirements for the same Level of Care (LOC), e.g., for attendance-based IOP, Aetna requires 2 hours and BCBS requires 4 hours. There are a few ways to address this difference within the Kipu EMR to ensure that billing occurs as accurately as possible. 

• Set up the LOC with the smallest hour requirement (e.g., 2 hours for Aetna) 
  • Pro: One LOC, no yellow warnings on the billing audit tool report if the minimum hour requirement is met.
  • Con: The biller will have to make sure the hour requirements are met for payers who differ from the minimum hour requirement listed on the LOC. (e.g., BCBS in this example).
• Set up two LOCs with different hour requirements.
  • Pro: The biller can ensure the minimum required hours for the specific payer are being met.
  • Con: The user who adds the utilization review (authorization) must know the insurance company and select the correct LOC on the authorization for the system to work properly.