Private Pay: Ancillary Workflow (Avea Integration)

Let's review the process for treating patients without insurance (e.g., Private Pay) and billing the patient for ancillary treatments with the Kipu EMR and Avea Integration.

Important: Private Pay billing is only available for clients who have purchased the Patient Billing Add-on for Avea. 

The process below can be used to bill Ancillary (standalone) services for Private Pay patients. For instructions on billing Private Pay patients for Level of Care (per-diem) services, click here. 

System Configuration - CRM

Let's review how to configure the Patient Information in the CRM. 

1. In the Patient Information window, set the Method of Payment field to Private Pay when creating the Patient Record.
2. This  will automatically set the patient's Payment Method to Private Pay in the EMR. 
3. Once you've accepted the incoming patient from the CRM or created the patient record directly in the EMR, please ensure that all required fields are completed as outlined in this document, including at least one diagnosis code.

System Configuration - EMR

Let's review how to configure the Payment Method for ancillary services. 

Confirm all Payment Methods are mapped correctly

1. In the upper-right corner, select User Initials > Settings > Patients.
   
2. Under Patients, scroll down to Payment Methods.
3. Confirm any Private Pay, Scholarship, or Self-Pay categories are mapped to Private Pay.
4. In the Category,  update the method to Private Pay then select Update to save the changes.

Update Payment Method in Facesheet

1. Open the Patient Chart.
2. Select Edit Patient.
   
3. In the Edit section, scroll down to Payment Method.
4. Under Payment Method, select Private Pay.
   
5. Scroll down and select Update to save your changes.
   
6. After updating your changes, select Show Facesheet to confirm the updated Payment Method is now set to Private Pay.
   

Note: The Payment Method can only be either Private Pay or Insurance, but not both at the same time.

Update Insurance Information in Facesheet

The Payment Method is what drives the integration to recognize Private Pay services are being rendered. While it is recommended to update the Insurance Information to Private Pay, it is not required.

1. To update the Insurance Information, select Manage Insurance in the Patient Chart.
   
2. In the Insurance Set window, select Set To Private Pay.
   
3. Select the Effective Date before selecting Create.
   
   
4. After selecting Create, select Close & Refresh to update the Insurance Information in the EMR.
   

Tip: If there is an existing Insurance Set, it is recommended that a Termination Date be included when applicable. 

System Configuration - Avea

When a Private Pay charge is transmitted, the system will use the Service Rate referenced within the Facility to determine the amount of each charge. If a Patient needs to be charged a different rate, a Service Rate will need to be created.

1. Navigate to Patient > Treatment Episode > Scheduling and Utilization > Service Rates.
   
2. Under Service Rates, select Add Service Rate.
3. Update the Service Rate Type to Private Pay.
   
4. Next, select the Start Date and End Date of the rate. This date range should encompass all Dates of Service to prevent transmission errors. 
5. Then select the Facility to generate the Service and Rendering Provider lists.
   
6. Select the Service and Rendering Provider before updating the Unit Rate. 
7. Once the Unit Rate has been updated, select Add to set the rate.
    

Private Pay Patient Workflow

Let's review the Private Pay Patient Workflow.

1. Document the patient's treatments using the ancillary Evaluation and/or Group Sessions you've configured with your Private Pay codes. Click here to learn more about creating billable templates.
2. Submit those treatment codes to Avea from the Billing Report.
3. The Patient's charges will appear on the Attendance Calendar in Avea.
4. Click Submit Treatments for Billing to send the charges to the Work Center.
5. After you have submitted the treatments, follow steps 7-12 in this article: Generate Patient Billables for Private Pay to complete the process.