Create Billable Services - EMR + RCM

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Creating billable services for the EMR + RCM is a multi-step process in each system. Creating these services in the correct order of operations is key to ensuring treatments are recorded correctly and transmitted to the RCM for billing.

User Permissions

Let's review the permissions needed to create a service in each system.

In the EMR In the RCM
Only Super Admins can create services in the EMR. For more information on user profiles in the EMR, click here. Only Admin-level users can create and manage services in the RCM. For more information on user profiles, click here.

Services Types

There are two types of services in the RCM: standalone services and U/R required services. However, the EMR uses slightly different terminology for each type. 

Service Type In The EMR Requires Authorization
U/R Required Level of Care Yes - an authroization or utilization plan will be required.
Standalone Ancillary No - standalone services do not require a U/R plan in the RCM. However, these services can be configured to require one in the EMR.

Create U/R Required Services

When creating a new U/R Required service (also known as a Level of Care), a few crucial steps must be completed to ensure the service maps properly across the systems.

  • The EMR supports three types of codes: CCodes, RCodes, and HCodes. When billing institutionally, an RCode will always be required. However, HCodes are an optional.

    • In this example, the code Type is RCode, and the corresponding 4-digit number is in the Code field. 
    • In this example, the code Type is HCode, and the corresponding 5-digit number is in the Code field. 

    Click here for step-by-step instructions on creating Codes. 

  • Create a new Level of Care for the PHP per-diem service. Levels of Care are configured under Settings > Patients. You'll notice that we selected the RCode and HCode we previously built and input the Type of Bill (Bill-Type Prefix)to finish building the LOC.

    Click here for step-by-step instructions on creating Levels of Care. 

  • Build the Service in the RCM by navigating to the Practice Admin > Services tab. 

    When creating the service, it's important to:

    1. Select the correct Level of Care from the drop-down for reporting purposes.
    2. Toggle on the Attendance Calendar - Requires Utilization Plan or Service Rate setting. This requires the patient to have a U/R plan for this level of care before it can be billed. 
    3. Select the correct Kipu Level of Care Service from the drop-down. This list contains the Levels of Care configured in the Kipu EMR under Settings > Patients. 

    Click here for step-by-step instructions on creating a Service. 

  • Build the Service Billing Profile for the service to set the billing standards. 

    When building the Service Billing Profile:

    1. Confirm the defaulted Claim Type to the Claim Format set in the EMR Level of Care (e.g., match institutional to institutional).  
    2. We recommend toggling on the Require Preferred Claim Type setting.
    3. Enter the Institutional Revenue code, this should match the RCode added to the EMR Level of Care.
    4. If used, enter the Institutional HCPCS/CPT code; this should match the HCode added to the EMR Level of Care.
    5. Set the Institutional Bill Type Prefix; this should match the Type of Bill field in the EMR Level of Care.

    Click here for step-by-step instructions for building Service Billing Profiles. 

  • The last step is to reference the service and set a service rate at each facility that should be able to bill this service. This occurs under Practice Admin > Facilities > Facility Service Rates.

    Select the correct Service to generate the Service Billing Profile list and input the Institutional Unit Rate ($).

    Click here for step-by-step instructions on setting facility rates.

Create Standalone Services

Creating an ancillary service for the integration is a four-step process that requires correct execution to ensure billable charges are transmitted accurately.

  • The first step is to set up the EMR code we want to bill for the service. The Kipu EMR supports three types of codes:

    • CCodes for professional claims
    • RCodes (required to bill) and HCodes (optional) for institutional claims 

    In this example, we'll show how to create a new ancillary service for Group Therapy that we intend to bill as a professional service using code 90853. 

    • Because we are creating a service that will bill on a professional claim form, we'll make the 90853 a CCode.
    • The Description name should always match the Service name in the RCM. When transmitting the charge to the RCM, the system must match the Description name to the Service name and the CCode to the CPT Code set in the billing profile to successfully transmit the charge. Please note that neither field accepts parentheses. 
    • Add the Effective Date of the code before clicking Submit.

       

    Click here for step-by-step instructions on creating Codes. 

  • Next, build the Service in the RCM Practice Admin under the Services tab. 

    When creating the service, it's important to:

    1. Ensure the Name field matches the EMR code Description field exactly.
    2. Select the Ancillary from the Level of Care drop-down for reporting purposes.
    3. Leave the Attendance Calendar - Requires Utilization Plan or Service Rate setting toggled off.
    4. Do not select a Service from the Kipu Standalone Service drop-down.

    Click here for step-by-step instructions on creating a Service.

  • Next, create the Service Billing Profile for the service to set the billing standards. 

    When building the Service Billing Profile:

    1. Set the Preferred Claim Type to the desired claim format, in this example, Professional. 
    2. We recommend toggling on the Require Preferred Claim Type setting. 
    3. For Institutional claims, enter the Revenue Code. 
    4. Include an Institutional HCPCS/CPT Code as needed. 
    5. Set the Institutional Bill Type Prefix, even for professional claims. You can use a placeholder if needed.
    6. When building a Professional Service Billing Profile, match the same Professional Place of Service field on the Service in the RCM as it appears in the EMR Service.
    7. Set the HCPCS Unit Measurement Basis to Units for anything that isn't per-diem billing. 
    Follow the instructions for setting up Professional Services to add the HCPCS/CPT Code which should match the CCode in the EMR Service. 

    Click here for step-by-step instructions for building Service Billing Profiles. 

  • The last step is to reference the service and set a service rate at each facility that should be able to bill this service. This occurs under Practice Admin > Facilities > Facility Services.

    When adding a facility rate:

    1. Select the correct Service.
    2. Choose the related Billing Profile.
    3. An Institutional/Patient Billing Unit Rate is required regardless of whether you are billing institutional or patients for this service.
    4. For Professional Services, you'll have another line to add in the Professional Unit Rate in addition to the Institutional/Patient Billing Unit Rate. 

    Click here for step-by-step instructions on setting facility rates.

Create Standalone Services - Authorization Required

Standalone Services, also known as Ancillary Services, are created using a 5-step process similar to creating a Level of Care (U/R required service).

  • The EMR supports three types of codes:

    • CCodes for professional claims
    • RCodes (required to bill)
    • HCodes (optional) for institutional claims 

    In this example, we'll show how to create a new ancillary service for Individual Therapy - 60 minutes that we intend to bill professionally with code 90837.

    • Because we are creating a service that will bill on a professional claim form, we'll make the 90837 a CCode.
    • The description name should always match the service name in the RCM. When transmitting the charge to the RCM, the system must match the description name to the service name and the CCode to the CPT Code set in the billing profile to successfully transmit the charge. Please note that neither field accepts parentheses.
    • Include the effective date in the corresponding field and click Submit to finish.

    Click here for step-by-step instructions on creating codes. 

  • A new service for Individual Therapy - 60 Minutes will be created. Services are configured under Settings > Billing Audit Tool> Services. Ensure the Service Name field matches the code's description and select the corresponding code in the CCode field.

    Click here for step-by-step instructions on creating services. 

  • Build the service in the RCM Practice Admin under the Services tab. 

    When creating the service, it's important to:

    1. Select the Ancillary from the Level of Care drop-down for reporting purposes.
    2. Leave the Attendance Calendar - Requires Utilization Plan or Service Rate setting toggled off.
    3. Select the correct Kipu standalone service from the drop-down. This list contains the services configured in the Kipu EMR under Settings > Billing Audit Tool > Services. 

    Click here for step-by-step instructions on creating a service. 

  • Create the service billing profile for the service to set the billing standards.

    When building the service billing profile:

    1. Set the Preferred Claim Type to the claim format set in the EMR Service(e.g., match professional to professional, etc.).  
    2. We recommend toggling on the Require Preferred Claim Type option. 
    3. Enter the institutional revenue code, even for professional claims. You can use a placeholder if needed. 
    4. Set the Institutional Bill Type Prefix, even for professional claims. You can use a placeholder if needed.
    5. When building a professional service billing profile be sure to select the same Professional Place of Service field option on both the EMR and RCM services.
    6. Set the HCPCS Unit Measurement Basis field to Units for anything that isn't per-diem billing. 
    Additionally, please follow the instructions for setting up professional services to add the HCPCS/CPT code, which should match the CCode in the EMR service. 

    Click here for step-by-step instructions for building service billing profiles. 

  • The last step is to navigate to Practice Admin > Facilities > Facility Services, reference the service, and set a service rate at each of the facilities that should be able to bill this service. 

    When adding a facility rate:

    1. Select the correct service.
    2. Choose the related billing profile.
    3. The Institutional/Patient Billing Unit Rate field is required regardless of whether you are billing institutional or patients for this service.
    4. For professional services, you'll have another line to add the professional unit rate in addition to the Institutional/Patient Billing Unit Rate field.

    Click here for step-by-step instructions on setting facility rates. 

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