Setting Up Billing Formats

●     Bill Negative Pressure Wound Therapy— Select this to enable billing functionality for dNPWT services. Refer to the 16.11.3 release guide for more information about this feature.

●     Create Claim with Billable Days Itemized — Select this checkbox if you want data in the claim to be displayed with itemized billable days.

●     Do not report units in 15 minute increments — Select this option if you do not want to record any units in 15-minute increments.

●     Group Supplies — Select this check box to group supplies (270 & 623 revenue codes) into aggregated line items per code.

●     Include Details — Select this checkbox so the billing form displays an itemized list of each service.

This option will only display for the Payor Invoice and Patient Invoice billing format types.

●     Include Discharge Hour— Select this option to include the time that the patient was discharged.

●     Include Location of Service on claim — Select this check box to include the service location on the claim.

●     *Include Agency as Rendering Provider— Select this option to list the ordering physician with associated services in 1500 (02-12) claims if the Ordering box is also checked for the physician (in Patients | Intake / Referral | Physicians).

●     *Include Ordering Provider— Agency office will be listed on the claim as the rendering provider. If this box is not checked, the software will not include the rendering provider on the claim.*

●     *Include Place of Service Code— When checked, the software will automatically include the place of service code that is associated with the location code selected for the patient level of care, as long as a Place of Service Code has been assigned (in Reference Files | Location Codes). *

*These options will only display when the "1500(02-12)" option is selected in the Type field. These settings were added specifically for Ohio Medicaid, which requires certain information for HCFA 1500 (02-12) claims[Rendering provider (i.e. agency office ) must be included on claim. Ordering provider and place of service must be listed for each service/visit line in the claim file ], but other payors may require this information as well. Agencies can use these features for any payor, but only when the billing type is set to "1500(02-12)".

●     Include Service Detail overrides on Transfer claim— Enables software to use overrides (in Master Files | Payors / Plans | Service Dtl) for the secondary payor that a claim is transferred to. When checked, the software will populate the Revenue Code, HCPCS code, Modifier, and Unit Measure overrides on the secondary claim. Billable and price override details will not be used, due to balancing in Account Summary. When not checked, the software will use the primary payor service details, as listed on the primary bill when the transfer claim is created.

In order to balance out the account properly on the secondary claim, the software will display the visit price for each line item as the price that was billed to the primary payor. In Account Summary, the net amount will reflect what the secondary payor is expected to pay.

●     Incremental Continous Care — Select this checkbox if the service is incremental continuous care.

●     Post SIA Adjustment — If desired, select this checkbox to automatically calculate an SIA (Service Intensity Add-On) as an adjustment and post it to Accounts Receivable). By default, this feature is set to "off" for plans that are not Medicare.

●     Post service detail fee overrides as Contractual Allowance — Select this check box if you want to post any service detail fee overrides (those found on the Service Detail tab at the plan level) as a contractual allowance.

●     Reports units in 15 min inc. - 1500 billing format only — Select this option if you want to record units in 15-minute increments only.

●     Use MBI on claims— When this box is checked, the Medicare Beneficiary Identifier (MBI) will be included on claims, in NOE Link, and with Eligibility features (instead of the HICN) if an MBI is entered for the patient (in Patients | Intake / Referral | Insurance). If no MBI is present, the software will continue to use the HICN.
 
This option is only available for Medicare payors that have the Payment Source set as "Medicare A" (in the Payors tab) and is available for any option that is selected in the form Type field.

●     Include FIPS code on claims — This checkbox determines whether or not FIPS (Federal Information Processing Standard) county codes will display on the corresponding claims. This option is only available for UB04 forms. When this option is selected, FIPS codes will be included on any claims with value code 85.

●     Use specified number of units — If you want to use a specific number of units, select this check box and enter the number of units in the available field.

 

The checkboxes that display in the Form section are determined by the payor and/or plan that is selected.

 

 

●     State Form — Click the arrow in this field and select the state.

●     Revenue Description — Enter the revenue description for form locator 43.

●     Calculate Covered Days — Select this check box if you want to include covered days on claims (typically for Medicaid and R&B plans).

●     Exclude Date of Revocation — Select this check box if this plan does not bill for date of revocation.

●     Exclude Date of Death — Select this check box if this plan does not bill for date of death.

Designate a discipline as "Covered" by checking the box in the Covered column for the corresponding record. Exclude a record from the list of covered disciplines by unchecking the appropriate box, or click Unselect All to exclude all disciplines in the list.

●     Disciplines that are available for selection in this section are populated based on the list setup in Reference Files | Discipline Codes.

●     Checking the Covered box for each record affects how users are able to interact with the discipline in other areas of the software:

o     When Covered is checked: The discipline will be available for selection in the various Discipline drop-down fields throughout the software, allowing users to schedule and assign this discipline to any patient that has this plan listed in the Insurance screen.

o     When Covered is not checked: This discipline will not be available for selection in the Discipline fields when users are created orders and authorizations, scheduling visits, or assigning/re-assigning payors to visits. If a user attempts to assign a payor to a visit and the corresponding discipline is not covered by the associated plan, the payor will not be available for selection in the Payor drop-down field.

●     If the Schedule from Auth box is checked (in Master Files | Payors / Plans | Plans), the software will only display disciplines marked as "Covered" when a user creates an authorization for the plan.

 

o     Itemize Services

o     Group by Revenue Code

o     Group by Revenue Code and Date

o     Group by Date, Revenue Code, and HCPCS

 

o     Single Service on Start Date

o     Single Service on End Date

o     Separate Service on Actual Date

 

●     Use Doctor's NPI

●     Use Provider's NPI

●     Use Medicare Provider Number