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Billing Code Matrix (article)

Summary:

The Billing Matrix is designed for you to create a special bill code setup that requires something different from your regular bill codes setup. In other words, the billing matrix is for use when a billing code has a different requirement other than what your system is normally set up for in PIMSY. For instance, you may have an insurance company that requires a modifier or a different modifier from the one normally used for a specific insurance company. You can use the Billing Matrix to set a new rule for that particular insurance company, user, billing code or combination.

Columns:

User – the clinician for whom you are setting up billing codes.

Insurance Company – the insurance company that will be billed those codes.

Billable Code – a code for your special billing circumstances.

Modifier – any required modifiers for a code.

Description – a description of your special code.

Instructions:

  1. Go to the Financial menu and select Billing Matrix.
  2. Select a Clinician, insurance company, and each billing code that they will bill. Then select all other items that will apply. This may be a modifier, billing rate/unit or other exception for a code that is specific for the chosen insurance.

Use the Column Chooser to add fields you need to change but are not yet visible. Right-click over a column head to bring up the Column Chooser.

Enter in a valid start and end date. Click Save.

Use Case:

Joe Smith is a user at the ABC Therapeutic and has insurance that normally requires a default modifier for most customers. However, Joe’s insurance company requires a special modifier for his account. To fix this for Joe without disturbing the default modifiers, the administrator adds a special code in the Billing Matrix including the modifier and a description for future reference.

PIMSY first looks at the billing code matrix before it calculates billing for Joe and picks up the special modifier for just his billing. Because of the billing matrix, the correct code is on the insurance billing for user Joe Smith instead of the default code for that 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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