Case Settings - Note Rules - Billing Rules

UPDATE: 
Renamed the Top 10 Insurance report to Patient Mix Report

New case Setting option added under Billing Rules > Allow Unit Modification

Added Exclude Discipline Modifiers option under Case Settings > Billing Rules

Added new checkbox for "Ordering Provider"

Billing Rules > Add option for Institutional Claim(UB-04)

Added “Require Medical and Treatment DX”

Added AI Similarity Check

Added DX Pointers

Added Hold Billing

Added Daily Note AI Similarity Check

Purpose:

To provide users the meaning of each Case Setting.

GENERAL SETTINGS:

ORDERING PROVIDER - Ordering Provider is not meant to be selected if you want it to populate on box#17 on the CMS1500 form. This is meant for specific insurances, such as DME. Please do not click ordering provider if you want it to populate.

OFFICE LOCATION – office location set for the case

PROFILE – case profile (Default, Pediatric, Basic, Billing, Wellness)

CASE TITLE – the name of the case

RICH TEXT WITH TABLE/AUTOCOMPLETE – will Enable Rick Text to your notes which includes Table and AutoComplete

CASE MANAGER – This will show all office manager and staff users. You can then use the patient list filter to isolate any patients that are connected to the case manager.

PRIMARY INSURANCE - patient’s primary insurance set in the Insurance Tab

SECONDARY INSURANCE – patient’s secondary insurance set in the Insurance Tab

REFERRING PROVIDER – referring provider of the patient

CASE DATE – date when the case was created

ASSIGNED THERAPIST – primary therapist assigned to the case

SECONDARY THERAPIST - secondary therapist assigned to the case

CASE TYPE – select the case type in the drop down (Medicare Part B, Self Pay etc)

PLACE OF SERVICE – place of service for the case

KX THRESHOLD START – start amount of the therapy cap you want the case to start with

BYPASS KX – used to bypass kx modifiers

NOTE RULES:

REQUIRE COSIGN – this is used to require all notes to be done in the case to require cosign

TIME IN/OUT – used to require time in and out for notes created in the case

CHECK SCHEDULE – used to require a schedule created first before notes are finalized

DISABLE CARRY OVER – used to disable carrying over data from previous notes and to be able to create new notes even if the current note is in draft

PROGRESS NOTE MIN/MAX – used to specify progress note notifications

DAILY NOTE CPT – used to be able to manually select/update cpt codes on each note

ALLOW CO-TREAMENT – This feature allows you to co-treat with another physician

POC EXPIRATION LOCK – If a POC is expired, therapists will not be able to do their note note.

NOTE COUNT START – specify the note count of the first note created

DAILY NOTE AI SIMILARITY CHECK – requires therapists to modify their notes prior to their last note to avoid exact text. This helps ensure therapists are complying with documentation and avoiding denials.

DAILY NOTE ICD/GOALS – allows therapists to update ICD10 codes and goals within daily notes.

PREVENT CROSS CASE NOTES – will not let a therapist finalize a note on the same day if another therapist from another case documented on the same day.

AUTO EFAX POC – used t o automatically fax out POC to referring provider

AUTO EMAIL POC - used to automatically email POC to referring provider

REQUIRE VISIT TYPE - schedule created under this case is required to have a visit type assigned

HIDE CASE FROM NON-ASSIGNED - shows the case only to the assigned therapist

REQUIRE MEDICAL AND TREATMENT DX - notes needs to have at least 1 medical and 1 treatment dx

REQUIRE EVALUATION CODE BILLED - needs to have to have the evaluation code be billed

BILLING RULES:

NO AUTHORIZATION – used when no authorization is needed for the case

APPLY KX – used to force apply kx modifiers to all notes in the case

BILL MEDICAL/TREATMENT DX – This feature is to be utilized for certain insurances that require the Medical as well as the Treatment DX to be billed

8-MINUTE RULE – This feature will apply 8-minute rule guidelines to the billing, for medicare purposes

AMA BILLING – This feature will apply AMA guidelines to the billing

APPLY ASSISTANT MODIFIERS – used to automatically apply assistant modifiers to therapy assistants

APPLY MODIFIER – used to apply specific modifiers that you want

SERVICE LOCATION BOX 32 - For most billing, it is the office location, however some MACs (Medicare Administrative Contractor) are requesting this box to be empty when submitting billing. This allows you to control what you need in this box to ensure your claims are being processed properly. If you have not had any billing issues, you can put "Office" here.

AUTO HOLD - when enabled, this will put all finalized notes within the case to be put on hold automatically from when the setting is enabled.

HOLD BILLING - A case with "Hold Billing" enabled is excluded from Ready to Send (list, preview, export) only. The same case still appears normally on Audited and Submitted tabs. Unchecking "Hold Billing" restores the case to Ready to Send.

DX POINTERS - If this rule is turned on, then expose the "DX POINTER" column on the billing grid, which will allow therapists to input which DX are populated on the 837 file (per service line)