1. AWARDS
  2. Billing
  3. AccuBill

Configuring Procedures in AccuBill

Updated

Procedures are configured in the Configuration Mgmt module in AccuBill. There, you'll maintain the list of procedures that can be billed to payers. Procedures can also be known as a listing of service codes, with billing/claim requirements and rates defined.

Permissions Needed

To manage your agency's procedures in AccuBill, you'll need the following permission:

  • Configuration Mgmt. > Procedures > CREATE or UPDATE or DELETE, and/or; 
  • Configuration Mgmt. > Procedures > Billing Rates > CREATE or UPDATE or DELETE

Configuring Procedures

Follow the guide below to configure procedures in AccuBill.

 

 

Creating a New Procedure

To begin creating a new Procedure, follow the steps below:

  1. Click the green Create button.
  2. Within the form, fill out the following sections:
    1. General Information
      1. Name - Required
        1. This is the name for the procedure
      2. Start Date - Required
        1. This is the start date in which events can be billed using the procedure. This is event (service) date sensitive.
      3. Active
        1. Defaults to Yes, but can be switched to no to make the procedure Inactive. Note: Inactive procedures will not be considered for billing, even if all billing requirements are met.
      4. + Add More Settings - Situational/Optional
        1. Click this to open the right navigation bar, Additional Settings. Note: If additional settings are added to the form, they must be filled out.
          1. End Date
            1. This is the end date in which events can be billed using the procedure. This is event (service) date sensitive.
          2. Procedure Group
            1. Associated a procedure group with the procedure. This allows procedures to be better organized and is also a filter when creating charges. Note: This list comes from Account Mgmt. > List Creator > Procedure Groups.
    2. Billing Requirements
      1. Payers - Required
        1. Select the payers that this procedure can be billed to
      2. Programs - Required
        1. Select the programs that can have their services bill this procedure
      3. Billing Frequency (once per) - Required
        1. Select how often the procedure can be billed
          1. Day
          2. Event
          3. Month
          4. Week
      4. Event Types - Required
        1. Select the event types that can be used to bill the procedure
          1. Attendance - Includes: Program Attendance (Reception Desk > Program Attendance) & Group Attendance (Services - Group > Group Activities AND Reception Desk > Group Activities)
          2. Charting Timetable - Includes: Charting Timetable (Services - Individual > Charting Timetable)
          3. Housing - Includes: Nightly Absences (Housing > Nightly Absences)
          4. ProgramStay - Includes: The consumers program history
          5. Service - Includes: Contacts Log, Group Notes, Progress Notes, Transportation (All found within Services - Individual)
      5. + Add More Settings - Situational
        1. Click this to open the right navigation bar, Additional Settings. Note: If additional settings are added to the form, they must be filled out. Also, the list of additional settings will vary based on the selection(s) made from the Event Types setting.
          1. Additional Procedure Consideration
          2. Consumer Age Minimum/Maximum
          3. Service Event Types
            1. Activity Types
            2. Bill Pre-Admission Service Dates
            3. Contact Methods
            4. Crisis/Routine
            5. Electronic Signature Required
            6. Face to Face
            7. Forms - Note: Options are displayed based on programs selected.
            8. Group Attendee Count Minimum/Maximum
            9. Interactive Complexity
            10. Languages
            11. Note Writer Credentials
            12. Note Writer NPI
            13. Note/Log Locations - Note: Options are displayed based on programs selected.
            14. Progress Note Configurable Dropdown (Ratio) - Note: This settling will only display if a program was selected that uses this progress note setting in AWARDS. Additionally, the AWARDS setting labels and values will also be displayed for each program that has them set.
            15. Progress Note Types - Note: Options are displayed based on programs selected.
            16. Service Event Days Count Minimum/Maximum
            17. Service Event Duration Minimum/Maximum - Note: Exceptions can be set for this by payer.
            18. Service Event Start Time Start/End
            19. Service Events Count Minimum/Maximum
            20. Service Plan Linked
            21. Service Types - Note: Options are displayed based on programs selected.
            22. Telehealth Required
          4. Weekdays
    3. Claim Requirements
      1. Billing Rates - Required
        1. Click Create Billing Rates
          1. Within the modal, fill out the following sections:
            1. Name - Optional
            2. Billing Rate - Required
            3. Start Date - Required
            4. End Date - Optional
            5. Payers - Optional
            6. Programs - Optional
            7. Note Writer Credentials - Optional
            8. Note/Log Locations - Optional
            9. Consumer Age Minimum - Optional
            10. Consumer Age Maximum - Optional
        2. Created billing rates will appear on the main screen and can be edited, duplicated, or deleted by clicking the actions icon Action Menu
      2. Claim Amount Multiplier Calculation - Required
        1. From the dropdown select:
          1. 1 Unit - 1 claim unit will be billed for the procedure
          2. Duration - Claim units are calculated and billed based on the duration of the service using the additional settings provided:
            1. 1 unit of measure = ______ minute(s) AND ______ unit(s) of measure = 1 claim unit - enter the unit of measure values (eg: If 1 and 15 were entered, a claim unit would be calculated for each 15 minutes of service)
            2. No rounding, require full units of measure to calculate claim units - selecting this will not using rounding to calculate claim units
            3. Apply natural rounding to units of measure remainder - selecting this will round down or up based on the number of partial units
            4. Count _____ or more remaining minutes as whole units of measure - selecting this will round up based on the number entered in the field provided
            5. Apply natural rounding to claim units remainder - selecting this will round down or up based on the number of partial units
            6. Count _____ or more claim units as whole claim units - selecting this will round up based on the number entered in the field provided
            7. First calculate individual event units and then sum all event units together - Select this to first calculate units at the event level and then add the individual unit together
            8. Deduct _____ event minute(s) from claim unit calculation - enter a value to deduct from the claim unit calculation (eg: enter 5 to deduct 5 minutes duration from the unit calculation)
            9. Round partial claim units to nearest - Claim units are rounded further based on the three options below
            10. Don't Round - Selecting this will allow claim units to calculate past the hundredth place
            11. Tenth - Selecting this will not allow claim units to calculate past the tenth place
            12. Hundredth - Selecting this will not allow claim units to calculate past the hundredth place
          3. Custom Unit Type - Claim units are calculated and billed based on the options within the Select One dropdown and the additional settings provided: Note: This settling will only display if a program was selected that uses this progress note setting in AWARDS.
            1. 1 unit = ______ - enter the value associated with the selection from the Select One dropdown
            2. Select One dropdown - select the type to calculate units from
            3. Apply rounding down - selecting this will always round down based on the number of partial units
            4. Apply rounding up - selecting this will always round up based on the number of partial units
            5. Apply natural rounding - selecting this will round down or up based on the number of partial units
            6. Count ______ remaining number of units as whole claim units - selecting this will round up based on the number entered in the field provided
            7. Billable unit count maximum - enter a value here to cap the number of units that can be billed for this procedure when using the Custom Unit Type
        2. Note: Exceptions can be set for this by payer and/or program.

      3. + Add More Settings - Situational

        1. Click this to open the right navigation bar, Additional Settings. Note: If additional settings are added to the form, they must be filled out.

          1. File/Form Type

          2. Both Types - includes settings that can be used for both file/form types

            1. Measurement Code

            2. Procedure Code

            3. Procedure Code Modifiers

          3. 837P/CMS 1500 (HCFA) - includes settings just for this file/form type

          4. 837I/CMS 1450 (UB-04) - includes settings just for this file/form type

            1. Value Information

    4. Miscellaneous
      1. Notes - Optional
    5. Review
      1. Review the contents of the procedure and click Create the save the new procedure record.
        1. Note: If the checkbox called Reprocess All Billing Events is selected prior to clicking the Create button, all billing events will be reprocessed that haven’t been used to create a Charge record.

 

Procedures Table

Within the Procedures table, you’ll see the following tabs/columns:

Tabs

  • Active - Lists all procedures that are set to Active status. Note: This tab is selected by default.
  • Inactive - Lists all procedures that are set to Inactive status.
  • All - Lists all procedures, both Active and Inactive status'.

Columns

  • Name - Name for the procedure record
  • Procedure Group - Procedure group assigned to the procedure record
  • Start Date - Start date assigned to the procedure record
  • Status - Current status for the procedure record (Active or Inactive)
  • Payers - Payers assigned to the procedure record
  • Programs - Programs assigned to the procedure record
  • Active Billing Rates - List if billing rates that are active as of today
  • Last Modified - The date and time the procedure record last updated
  • ID - ID number assigned to the procedure record by AccuBill
  • Actions
    • View Record - Click to view and edit the procedure record
    • Change History - Lists all updates made to the procedure record
    • Delete Record - Click to delete the procedure record

 

Bulk Actions

By selecting at least one procedure record checkbox, a footer will appear with the following:

  • Cancel - Deselects records and hides footer
  • Export - Exports selected records from AccuBill
  • Compare - Compares multiple records side-by-side
    • Note: At least 2 records must be selected to activate this button
  • Duplicate - Creates a new record with the same data, just the name is different
  • Delete - Deletes the selected records

 

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