Service Codes & Service Fee Cross Reference Maintenance Option. Provided to you by Netsmart Technologies, Billing Support

Transcription

1 Service Codes & Service Fee Cross Reference Maintenance Option Provided to you by Netsmart Technologies, Billing Support

2 Tasks to be completed prior to using Turn on the registry setting Enable Fee Matrix Definition (if not already) Avatar PM > System Maintenance > Service Code Maintenance > Enable Fee Matrix Definition Ensure the user(s) who need access to the added option Service Fee/Cross Reference Maintenance have been given access through System Security

3 Setting Up Service Codes

4 Avatar PM 2006 Service Codes Form Notice that In Avatar PM 2006, the Service Code Cross Reference functionality appears as a tab on the Service Codes form. In Avatar PM 2008, the Service Code Cross Reference functionality has been removed from the Service Codes form, and instead has been added to the Service Fee form.

5 Avatar PM 2008 Service Codes Form Service Required By: Both will require a patient and a practitioner when being rendered. Client Only will not require a practitioner when being rendered. Provider will not allow for a patient to be associated with this service. Type of Service: Individual can only be used for one patient at a time, either in charge entry or in appointment scheduling. Group can only be used for groups. Type of Fee: Fixed Fee is per event. The fee will be the same regardless of minutes rendered (excluding any other function used). User Defined will charge the fee based on number of minutes the service is provided. Group Code: Used for reporting purposes only Earned Income Report, e.g. Insurance Charge Category: Used to include this service into a category for like insurance coverage Is This Service A Procedure: If answered Yes, the service can be identified as an ECT service

6 Is This An ECT Service: This allows the service to be used as an ECT service for PPS billing. Is This A Balance Forward Service Code: Used only for conversion; should not be used for normal business. Does This Code Have A Professional Component: Must be answered Yes if this service is to be billed on a HCFA 1500 or 837 Professional. Other Service Code Category: Used in other areas of Avatar to allow use of this service code for additional criteria (Roll up billing, e.g.). Worklist Frequency/Days of Inclusion: Used to identify how the service is used during the room and board worklist process. Is This Service A Visit: If answered Yes the service can be counted against managed care auths based on visits. Is This A Dental Service: Must be answered Yes for this service to be used on an ADA or 837 Dental file. HCFA Type of Service: Used for HCFA Per-Diem Service Code: Used to identify if this service should be included in a per-diem write-off. Service Type Code: Used for 270 only. Should this service be claimed but not displayed on the 837I file: See help message for specific functionality. The following fields are for ARRA Meaningful use reporting: Include Service in ARRA Measures Numerator Exclude Service in ARRA Measures Numerator Include Service in ARRA Measures Denominator Exclude Service in ARRA Measures Denominator Include Service in Exclusionary Value for the following ARRA Measures

7 Additional functionality for service codes Run a service code report. You can run the report for all services or specific service codes Reactivate any services codes that have been inactivated Assign service codes that can prompt the user suggesting additional services be rendered when the originating service is rendered. The additional services can be proposed or required

8 Service Fee/Cross Reference Maintenance

9 Purpose of Combining Fees and Cross References The ability to use effective dates on ALL set-ups now available The needed ability to define refined cross references with the same flexibility as fees The ability to have max/min liab amounts by Financial Class and/or Guarantor instead of just Guarantor The ability to identify a units over-ride at the Guarantor level for user defined services

10 Service Fee Cross Reference Maintenance Option Tabs

11 Service Fee/Cross Reference Maintenance Service Fee / Cross Reference Maintenance o Add or Edit service fees. Fees can be based on: Practitioner Category Practitioner Location Program Duration Range Age Range Modifier Client

12 Service Fee/Cross Reference Maintenance o If you are setting up your fee/cross reference by any of these criteria, identify them then proceed to page 2

13 Service Fee/Cross Reference Maintenance o If you are setting up your fee/cross reference by any of these criteria, identify them then proceed to page 3 o Duration (minutes) and Age are range fields.

14 Service Fee/Cross Reference Maintenance o You can continue to set up this fee/cross reference by modifier and/or Client ID o The 3 fields here, are added via Additional Service Fee Configuration Fields registry setting Identifies if the service fee is calculated by days in the month or by service. Default would be by service. o Continue to page 4 for your cross reference set up

15 Service Fee/Cross Reference Maintenance o You set up your cross reference information here This unit field is different from your service code set up unit. If you use this field the value entered here will over-ride your service code set up

16 Guarantor Definitions Guarantor Definitions o Add or Edit service fees/cross references based on: Practitioner Category and/or Practitioner Location and/or Program Duration and/or Age Range Financial Class and/or Guarantor Minimums/Maximums to distribute per service/unit

17 Guarantor Definition o If you are setting up your fee/cross reference by any of these criteria, identify them then proceed to page 2

18 Guarantor Definition o Here your fees and/or cross references can be set up by Duration/Age ranges, Financial Class/Guarantor or limit liability distributions

19 Guarantor Definition o Here you can identify combination of guarantors where the max amount will not exceed the identified amount o Enable Maximum Liability Assignment by Combination of Guarantors registry setting

20 Guarantor Definitions o You set up your cross reference information here This unit field is different from your service code set up unit. If you use this field the value entered here will over-ride your service code set up

21 If your report does not look like this, you may be using an edited version of the old report. Avatar will not update edited reports.

22 Restore Definitions o Restore definitions to before last import not last edits

23 Examples

24 Example 1: Vary HCPCS Codes by Service Duration In Service Code form, input a new service code

25 Individual therapy, fixed fee units, professional component

26 Input Cross Reference in Service Fee/Cross Reference Maintenance form On page 1: Select Enter New Enter Service Code and From Date

27 On page 2: Enter Duration Range Enter Fee

28 On page 3: Can leave blank

29 On page 4: Enter HCPCS code for specified duration Submit form

30 To enter another fee and HCPCS code for the same service, select the Service Fee/Cross Reference Maintenance form again On page 1: Select Enter New Enter Service Code and From Date

31 On page 2: Enter Duration Range Enter Fee

32 On page 3: Can leave blank

33 On page 4: Enter HCPCS code for specified duration Submit form

34 To review setup, generate Service Fee Definition report

35 Example 2: Enter New Fees Input New Fees in Service Fee/Cross Reference Maintenance form On Page 1: Enter Service Code Enter From Date of most recent fee

36 Then press Select Fee/Cross Ref to Edit/Default From Existing Row Select a row id to default from and press OK

37 When returned to page 1, enter new fee From Date

38 On page 2: Enter new fee

39 On page 3: Can leave blank

40 On page 4: Verify Revenue Code or HCPCS code Submit form

41 To verify new fee, generate Service Fee Definition report Notice previous fee now has lapse date one day prior to new fee date

42 To verify cross reference, click on Service Code Cross Reference link The cross reference remained the same, as it was not changed during entry

43 Example 3: Enter fees by Guarantor Select Service Fees/Cross Reference Maintenance form Select Guarantor Definitions tab On page 1: Select Enter New, and enter Service Code and From Date for fee

44 On page 2: Select Financial Class, or Guarantor Input Maximum Amount to Distribute Per Service, or Per Unit

45 On page 4: Enter Revenue Code or HCPCS Code cross reference Submit form

46 To enter another guarantor, select Guarantor Definitions tab again On page 1: Select Enter New Enter Service Code and From Date for fee

47 On page 2: Select Financial Class, or Guarantor Enter Maximum Amount to Distribute Per Service, or Per Unit

48 On page 4: Enter Revenue Code or HCPCS Code cross reference Submit form

49 To verify fees by guarantor, generate Maximum Liability Assignment by Guarantor Definition report

50 See example Client Ledger below CHG is full service charge of $ Guarantor Liability is BC/BS charge of $ Remaining $25.00 drops to Guarantor 99999; could define an adjustment guarantor to capture adjustment amounts (would need to define this guarantor per client)

51 Registry Settings

52 Avatar PM > System Maintenance -> Service Code Maintenance - Additional Service Fee Configuration fields Avatar PM -> Billing -> Paper Billing -> UB-92/UB-04 - Alternate Revenue Code Description Avatar PM -> System Maintenance -> Service Code Maintenance - Edit Service Fee Maintenance Display Sort Avatar PM -> System Maintenance -> Service Code Maintenance - Enable Maximum Liability Assignment By Combination of Guarantors Avatar PM -> System Maintenance -> Service Code Maintenance - Enable Minimum Liability Assignment Avatar PM -> Billing -> Electronic Billing -> All 837 Submissions - Enable Pricing/Re-Pricing Information Avatar PM -> System Maintenance -> Program Maintenance - Enable Program Search

53 Avatar PM > Billing -> Electronic Billing -> 837 Professional - File Information (Loop 2400) Avatar PM -> System Maintenance -> Program Maintenance - Filter Program Selection By Treatment Service(s) Avatar PM -> System Maintenance -> Service Code Maintenance - Include CPT-4 Modifier If Not First Instance For Service Data Avatar PM -> Billing -> Electronic Billing -> All 837 Submissions - Include Notes From Service Code Cross Reference Avatar PM -> Billing -> Electronic Billing -> 837 Professional - Service ID Qualifier (Loop 2400) Avatar PM -> Billing -> Electronic Billing -> 837 Institutional - Sort Claims By Medicaid Rate Code-Regular Avatar PM -> System Maintenance -> Service Code Maintenance - Specify Service Modifier Location/Concatenating Order

54 Added SQL Tables

55 Added SQL Tables SYSTEM.billing_tx_master_fee_table The following fields are added: ub_04_code, ub_04_value, modifier_x_ref, alt_rev_code_desc, mod_x_ref_frst_instance, x_ref_name, medicaid_rate_code_reg, medicaid_rate_code_fam, medicaid_rate_code_brf, medicaid_rate_code_grp, state_rp_code_1, state_rp_code_2, state_rp_code_3, state_rp_code_4, svc_unit_meas_code, svc_unit_meas_value, quantity, svc_id_qual_code, svc_id_qual_value, svc_id, note_ref_code, note_ref_value, note_ref_text, file_information, incident_to_svc_code, incident_to_svc_value, inc_cov_cat_code, inc_cov_cat_value_long, inc_cov_cat_value_short, pricing_method_code, pricing_method_value, pricing_org_id

56 Added SQL Tables SYSTEM.billing_tx_master_fee_audit The following fields are added: ub_04_code, modifier_x_ref, mod_x_ref_frst_instance, medicaid_rate_code_reg, medicaid_rate_code_brf, state_rp_code_1, state_rp_code_3, svc_unit_meas_code, quantity, svc_id_qual_value, note_ref_code, note_ref_text, incident_to_svc_code, inc_cov_cat_code, inc_cov_cat_value_short, pricing_method_value, ub_04_value, alt_rev_code_desc, x_ref_name, medicaid_rate_code_fam, medicaid_rate_code_grp, state_rp_code_2, state_rp_code_4, svc_unit_meas_value, svc_id_qual_code, svc_id, note_ref_value, file_information, incident_to_svc_value, inc_cov_cat_value_long, pricing_method_code, pricing_org_id

57 Added SQL Tables SYSTEM.billing_tx_max_liab_by_guar The following fields are added: ub_04_code, modifier_x_ref, mod_x_ref_frst_instance, medicaid_rate_code_reg, medicaid_rate_code_brf, state_rp_code_1, state_rp_code_3, svc_unit_meas_code, quantity, svc_id_qual_value, note_ref_code, note_ref_text, incident_to_svc_code, inc_cov_cat_code, inc_cov_cat_value_short, pricing_method_value, ub_04_value, alt_rev_code_desc, x_ref_name, medicaid_rate_code_fam, medicaid_rate_code_grp, state_rp_code_2, state_rp_code_4, svc_unit_meas_value, svc_id_qual_code, svc_id, note_ref_value, file_information, incident_to_svc_value, inc_cov_cat_value_long, pricing_method_code, pricing_org_id

58 Added SQL Tables SYSTEM.billing_tx_max_liab_by_guar_audit The following fields are added: ub_04_code, modifier_x_ref, mod_x_ref_frst_instance, medicaid_rate_code_reg, medicaid_rate_code_brf, state_rp_code_1, state_rp_code_3, svc_unit_meas_code, quantity, svc_id_qual_value, note_ref_code, note_ref_text, incident_to_svc_code, inc_cov_cat_code, inc_cov_cat_value_short, pricing_method_value, ub_04_value, alt_rev_code_desc, x_ref_name, medicaid_rate_code_fam, medicaid_rate_code_grp, state_rp_code_2, state_rp_code_4, svc_unit_meas_value, svc_id_qual_code, svc_id, note_ref_value, file_information, incident_to_svc_value, inc_cov_cat_value_long, pricing_method_code, pricing_org_id

59 ? Questions?