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How Does IOP Work in PIMSY?

Overview

When multiple services are provided and documented for a client but are not billable individually, instead falling under a per diem billing code, PIMSY offers IOP Settings to manage this workflow.

These settings help providers focus on documentation without worrying about who should generate the actual billable IOP or PHP note. PIMSY will automatically handle this based on the IOP configuration, streamlining the billing process and reducing the risk of duplicate or missed billing entries.
 

 

Required Permissions and Prerequisites 

  • This article is in reference to our Desktop application
  • Please ensure you have the appropriate profile assigned for billing
  • Settings:
    • -508  IOP Unit Threshold
    • -509  IOP Billable Note Duration in Minutes
    • -510  IOP User Group Name
    • -512  IOP - Automatically Create the IOP Notes X Days in arrears

    • -516  IOP - Include Released Note Only

       

 

Step-by-Step Instructions

 

 

Step 1: Understanding IOP Billing

PIMSY uses Billing Code Groups to determine which non-billable services count toward meeting the daily unit threshold required to generate a billable occurrence.

These groups are configured by your System Administrator, who will inform you which codes to document under (such as “602,” “IND THPY,” or “GROUP”). As long as your documented services fall under the designated codes, PIMSY will track the total and create the appropriate billable entry once the threshold is met.

Once the non-billable service threshold has been met, PIMSY will check the IOP Billable Group (under Billing Code Group) to determine which billable code to use. It compares the code group, which is set by your administrator, with the authorization codes listed on the client’s chart.

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. The client also has multiple billing codes for different time frames, much like a facility where people transfer level of care or step down.

It is critical that a client does not have overlapping billing codes assigned to the IOP Billable Group for the same time period. Doing so would result in the client being authorized for two billable services per day.

To ensure accurate billing:

  1. Verify the billable codes have valid start and end dates
  2. Verify there's a valid amount of units allotted and remaining
  3. If authorizations for additional levels of care aren’t available at the time of admission, that’s okay, as you can add them later when the authorization is received.

     

Step 3: Additional Information

  • Make sure your clients have a default clinician selected within the details tab of their client chart, as well as a Default Location and Default Location Code. This is what will populate the billable occurrence note.

 

 

 

 

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