MAT Billing

This feature is currently in limited release to a select group of clients and will be rolling out to everyone in the coming months.

Organizations with EMR integration can now bill for MAT-related treatments using the Kipu RCM. Kipu’s Medication-Assisted Treatment platform is designed to help OTP and OBOT facilities manage their MAT workflows. It supports both SciLog and Ivek dispensing pumps, manual dispensing, and a flexible, configurable queueing system that aligns with your facility’s specific workflow. Let's learn more about this exciting new feature!

How Does It Work?

When a charge is transmitted through the billable report in the EMR, an HL7 file is exchanged between the two systems. Like an EDI file, an HL7 file contains most of the information needed to convert charges into a claim. The details within this file will specify how MAT treatment will be billed. 

Traditionally, information such as the drug code, modifier, and/or place of service was sourced from the billing profile in the RCM. With the MAT billing module, this information will come directly from the HL7 file sent via the billable report.

In The EMR

MAT services are configured using the same processes outlined in this article. However, three key fields must be configured directly in the EMR to ensure successful transmission of the billable report: the Place of Service (POS), NDC Code, and any applicable service modifiers.

• The POS is configurable within the Level of Care (LOC) for per-diem services and the template when creating an ancillary evaluation. Additionally, this field can be altered using a payer rule and by manually editing the billable report before transmission.
• The NDC code is configured when adding a new medication to your inventory. 
• Similar to the POS, the service modifier is configurable within the Level of Care (LOC) for per-diem services and the template when creating an ancillary evaluation. Additionally, this field can be altered using a payer rule and by manually editing the billable report before transmission.

In The RCM - Integrated Billing

Because the billable report generates more charge information, less configuration is required in the RCM. Services in the RCM will still be configured using the normal workflow; however, several key areas require additional attention to ensure accuracy.

For information on MAT Billing for non-integrated clients, click here.

Service Names

Service names in the RCM are known as Code descriptions in the EMR. Because the billable report uses these two components to identify and match charges that should be billed, they must match.

For example, let's say you create an RCode 0126 and assign it a description of "Detox - 0126" in the EMR.

When you create the service in the RCM, you must enter "Detox - 0126" as the service name to ensure an exact match.

Claim Rules

There are several claim rules that can change the billing information, such as the POS or modifier. Because of this, it is important to ensure there are no conflicting rules that can unintentionally alter the contents of the claim before it is submitted. To learn more about claim rules in the RCM, click here.