Billing Audit Tool: Services

Create Services for any ancillary services (services not tied to a per-diem level of care) that require an authorization number to be attached when billed. The creation of the service links together the Evaluation/Group Session code with the patient's service concurrent review (authorization).

Services must be configured before adding a service authorization to the patient chart.

Service Classification Availability by Integration

Service Classification	CollaborateMD	Kipu RCM
MAT Dosing Service	✔
Medical	✔	✔
Mental Health	✔	✔
Per Diem Service	✔	✔
POC Laboratory	✔
Substance Abuse	✔	✔

Create Services

Let's review how to create a service. 

Important: For Kipu RCM, services are first mapped based on the service name, and if no match can be found, the system will then attempt to map based on the code. The integration only accepts an exact service name match; if there are services with the same name, the system will attempt to map the service based on the code. 

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

3. Next, click Services.
   
   
4. Click + Add Item.
5. Enter the service information in the New Service Window. Fields indicated with an asterisk (*) are required.
   1. Service Name: Enter the desired service name.
      1. Important: For organizations integrated with the RCM,  please do not use parentheses in the Name field to prevent errors in matching the codes between the systems.
   2. Start Date: When the code should be eligible for use.
   3. Codes: Enter one or more codes. Remember, these codes must have been previously added to the system under Settings > Billing Audit Tool > Codes for them to appear in the list for selection. When one or more codes are selected, both codes will be available for selection on the billing audit tool report.
   4. Classification: Select the best option from the drop-down.

      • If you select this option, additional Billing Provider, Konnector, Clinical Provider, and Referring Provider drop-downs will appear

        

        • Billing Provider:
          • Choose Konnector Billing Provider to select a provider who will appear as the default provider for this service on the billing audit tool report.
          • Choose Ordering Provider to set the MAT dosing ordering physician as the billing provider for MAT dosing billable items.
        • Konnector: If you select a konnector, you are assigning a default ancillary konnector where the billing audit tool report will be automatically sent upon transmission.
        • Clinical Provider
          • Choose Dispensing Provider to make them the referring provider for MAT billing.
          • Choose Ordering Provider to make them the referring provider for MAT billing.
        • Referring Provider: You can leave this field blank, or select Ordering Provider.
        • Note: Customers in Arizona can send the Box 19 clinical provider by choosing MAT Dosing Service, and selecting Dispensing Provider in the Clinical Provider box.
      • If you select this option, additional drop-downs will appear for the billing provider and konnector, allowing you to choose a default provider and default ancillary konnector for this service on the billing audit tool report. If a konnector is added the report will automatically be routed to the chosen option on transmission. Only one code will be chosen when this classification is selected. The code selected will be the first available code in the code system.
        • Note: If no konnector is chosen here, you can select the desired konnector from the report.

      • This service can be used for patients who already have an inpatient LOC per diem but need an additional daily charge that requires no additional documentation, such as a daily Room and Board charge. If you select this option, additional drop-downs will appear for the billing provider, konnector, and Type of Bill allowing you to choose a default provider, clinical provider, konnector, or enter a four digit, alphanumeric billing type code for this service on the billing audit tool report. Additionally, use the checkbox to indicate whether or not the service should create a billing item on the patient's discharge date. If a konnector is added the report will automatically be routed to the chosen option on transmission. If a type of bill code is entered, it will be automatically populated in the edit claim window. 

        

        • Note: If no konnector is chosen here, you can select the desired konnector from the report.
   5. Claim Format: Choose Professional or Institutional. This choice impacts which codes you should select, e.g., CCodes for Professional claims and HCodes/RCodes for Institutional claims.
   6. Location: Select the location (or locations) where this service should be available.
6. Click OK.
7. To edit an existing service, click on the edit pencil.
8. Make the desired changes and click Submit.

Using Services

To bill for the service and attach the required authorization number, you’ll need to add a Service Review (Billing Audit Tool: Service) and Evaluation/Group Session to the patient’s chart that contains the same service code selected from the Code drop-down. If there's a one-to-one match, meaning, a single code in the Service and a single code in the Evaluation/Group Session, that code will be billed out for the patient. 

However, if there are two or more codes in the service and in the form, whoever is rendering the service for the patient must remember to select the applicable code for the service being provided to the patient. Because both codes are authorized, they are both considered by the EMR to be approved services that can be billed, so it's crucial to pick the correct one.