IOP Billing for Users (article)


PIMSY has a feature for IOP billing or any other per diem service. These are services that are billed by the facility that cover multiple hours of non-billable documenting on a client’s chart daily.


PIMSY looks at Billing Code Groups to see what non-billable services qualify for the Unit threshold.

To set these up, go to Financial > Billing Code Groups

For the non-billable services (the codes the providers use for documentation purposes) add all codes that apply to the Billing Code Group - IOP Non Billable Group. In our example, the billing codes 602, IND THPY, and GROUP are all codes that will count toward the billable occurrence. This can be any code you wish to set up such as ACU-Acupuncture, NUTRI-Nutrition, EDU-Education, etc.

When the threshold has been met of the non-billables, PIMSY will then look and compare the codes that are under the Billing Code Group under IOP Billable Group to the client(s) that met the threshold that day. It will compare the code group you create, to see which of those billable codes are listed as an authorization on the clients 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 on them 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 a valid amount of units allotted and remaining. 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 clinician selected on their Client Details page, as well as a Default Location and Default Location Code. This is what will populate the billable occurrence note.


Four Settings:

508- IOP Unit Threshold - the value in the box by “Your Value” tells the system how many units of the Non Billable notes need to be performed each day to trigger PIMSY’s IOP feature to run. In our example, we have 1 unit.

509- IOP Billable Note Duration in Minutes - When the system automatically creates the billable note for the IOP occurrence, how many minutes should it be created for? Put that number in the field next to “Your Value”. In our example it will create a billable 0905 for 180 minutes (3 hours).

510- IOP User Group Name - If the system cannot create a billable note for a client, who should receive the alert? Create a user group by going to Administration> User Management> User Groups.

Place the name you’ve created in the box for Your Value. In our example, we have an IOP Notification Group.

Setting 512- IOP- Automatically Create the IOP Notes X days in arrears. The system will fire off every night to create the billable note, but how many days should you give providers to get the documenting notes in the non-billables. If you want to give them two days to get their notes in and released, then place a “2” in Your Value as we did in our example. When the system fires off a backup at night, it will go back to two days previously, to see if the threshold has been met, and create the billable note.

Use Case:

Alice AAA-Test Client is in IOP receiving services. Clinicians have documented their daily sessions, as well as non-billable services (602-generic 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. The system sees the day of July 31st, she had a valid authorization with units under billing code 0905. You can see the system created a billable occurrence note for the 0905, allowing clinicians to just document their time with the client.

Opening the Billable Occurrence note shows it is a generic note. However, by creating it, the system has now generated an invoice for the billers to send to the insurance company.

Related Articles:

If you cannot find what you need in this article, please contact Support (email) or call 877.334.8512 ext. 3.


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