Generate Patient Billables

In the RCM, Patient Billables records services rendered for which the patient may be responsible. Creating and approving these billables allows organizations to accurately track a patient's journey through the revenue cycle and increase their overall collection percentage by maximizing their reimbursement rates. These billables are created through closed insurance claims and private-pay treatments. 

Patient Billables from Closed Insurance Claims

When an insurance claim is closed, the RCM will automatically create a Patient Billable regardless of the remaining patient responsibility. The system determines the patient's responsibility by adding together all posted Co-Pay, Co-Insurance, Deductible, and PR- or OA-100+ adjustment codes. Since the system will use this information to generate the billable amount, it is essential to verify that the posted payment matches the allocations in the EOB.

1. To view the payment, select the Payments subtab within the Work Claim screen.
2. Next, locate the payment and click View EOBs.
3. Then, review the EOB and confirm that the Co-Pay, Co-Insurance, Deductible, and adjustment codes are entered accurately.
4. Once confirmed, click the Workflow subtab and click Close Claim Instance.
5. Confirm the claim closure by clicking Close again.
6. Navigate to the Work Center > Patient Billing > Approve Patient Billables section in the RCM, then locate the billable.
   
7. Click the box next to the billable and click Approve Patient Billables.
8. Finally, click Approve again to complete the process.

Warning: It is imperative to approve billables with $0 balances to ensure the revenue cycle is complete and data integrity remains intact.

Patient Billables from Private Pay Services

When a private-pay service, also known as a non-medical service, is recorded in the Attendance Calendar, the treatment must be submitted to the Work Center for conversion into a billable item, following a process similar to creating insurance claims.

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  1. Follow the process outlined here for recording standalone treatments in the Attendance Calendar.
  2. Next, click Submit for Billing.
  3. After submitting the attendance, navigate to the Work Center > Patient Billing > Create New Billables section of the RCM.
  4. Locate the patient and click the box next to their name or the service, and click Create New Patient Billables for Selected Treatments.
  5. Next, navigate to the Approve Patient Billables tab and click the box next to the billable you'd like to approve.
  6. Then click Approve Patient Billables.
  7. Finally, click Approve again to complete the process.

Common Errors and Resolutions

On occasion, a user may receive an error message when attempting to approve a billable for a patient. Let's review some of the most common errors received and how to resolve them.

Error Message	Resolution
The Service "[Service Name]" does not have a specified Service Description for Patient Statement for [Date of Service]	A description of the service must be present in the service's profile for the system to reference when generating the patient's statement. After the description has been added, delete and recreate the billable to resolve the error. For more information on configuring services, click here.
Upon approval validation, the contents of this patient billable instance has changed. Please delete and recreate this instance.	This error message indicates one or more fields of the billable instance have changed since it was originally created. Delete and recreate the billable instance to resolve the error.
The billable's Patient Responsibility is negative. Please adjust the claim payments' Patient Responsibility.	This indicates that the adjustment codes and amounts in the final insurance payment exceed the patient responsibility amount entered. To learn more about managing posted payments, click here.