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IOP Billing for Providers (article)

Summary:

When there are multiple services that are performed and documented on a client that are not billable themselves but are instead included in a per diem code, PIMSY can add the IOP Settings to accommodate this situation. This helps make it easier on providers to do their documenting, while not worrying about who needs to create the note for the billable IOP or PHP note.

Instructions:

PIMSY looks at Billing Code Groups to see what non billable services qualify for the Unit threshold. These will be set up by the System Administrator, who will let you know which codes to document under (such as “602, IND THPY, and GROUP). These are all codes that will count toward the threshold needed to create the billable occurrence.

When the threshold has been met on the non-billables, PIMSY will then look and compare the codes that are under the Billing Code Group under IOP Billable Group with the client(s) authorization. It will compare the code group that the administrators set to see which of those billable codes are listed as an authorization on the client’s chart. Whichever code it sees, it will create a note for the client for the date of service for which the non-billables were dated.

In our sample client, we have the non-billables assigned as Authorizations. She also has multiple billing codes for different time frames, much like a facility where people transfer level of care or step down.  It is extremely important that a client does not have two codes in their chart for the same time frame that are assigned to the IOP Billable Group. This would be authorizing a client for two billable occurrences each day. Make sure the billable codes have valid start and end dates with valid units. If you do not get the other levels of care authorizations when a client is admitted, that’s no problem. You can go back later and add it when the authorization comes in.

IMPORTANT TIPS: Make sure your clients have a default provider selected on their Client Detail page, as well as a Default Location and Default Location Code. This is what will populate the billable occurrence note:

Use Case:

Alice is in IOP receiving services. Providers have documented their daily individual sessions, as well as non-billable services (602-generic code) by doing regular notes in PIMSY with the non-billable code selected as the Billing Code. They met the threshold of 1 unit on July 31, 2016. During the nightly backup of PIMSY on August 2nd, PIMSY saw that there were enough units for Alice AAA-Test Client, so it compared the Billable IOP Codes Group to Alice’s authorization, to see that for the day of July 31st, she had a valid auth with units under billing code 0905. You can see the system created a billable occurrence note for the 0905, allowing providers to just document their time with the client.

The Billable Occurrence is a generic note but in creating it the system has now generated an invoice for the billers to send to the insurance company.

 

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