Add & Edit Billable Service Types

 
 

Create your Organization's commonly used Service Types using CPT Codes, as well as their Rates and positions to limit what Staff Positions are allowed to schedule Appointments with this Service Type.
 

 NOTE:   The American Medical Association owns the rights to all CPT® codes and is now enforcing the collection of licensing fees for each Rendering Provider who submits Claims utilizing these codes.

Add Billable Service Types

1. Click the Organization and Settings in the navigation bar.
2. Click the Billable Service Types tab.

   NOTE: You can also create non-billable service types. See Add & Edit Non-Billable Service Types for more information. 

3. Click +Add Service Type. The Add Service Type window opens.
   
   
    
4. Enter information and click Save Service Type. 
   
   
   
    IMPORTANT:   Add a billable service type for every individual payor you have and delete/archive everything that is defaulted in the system.  Please note you will want to enter every CPT code per payor. If that payor has different modifiers for that same CPT code, you must create another billable service type for that CPT with the modifier and rate.  Here is an example of billable service types:
   
   
    
   • Type - Select CPT Code or Non-CPT Code.
     CPT Code - This is the code used for submitting insurance claims and must be selected if billing to insurance. 
     Non-CPT Code - If you are not billing to insurance you may create your own code to use for billing purposes.
   • Name - This should be a Client Friendly name, not the CPT Code name.

      NOTE:  This is what the Client will see as Service Type on any Billing documents as well as in the Client Portal. Do not use things like "Tier 1 Rate," "Discounted Rate," or "New Rate," etc. Service Type names are specific to the payer so it is important to enter a name for each new Service Type. This name should begin with the payer name followed by the service type: 
     

   • Enter Rate for Service Type - The Rate is a per-unit rate. This relates to the Units below.
   • Type to search for CPT Code - This is the code used for submitting insurance claims and must be selected if billing to insurance.
   • Enable service type validation - when checked, any progress notes for this service type must have a duration within the specified range in order to be signed. See Sign Notes & Documents for more information. 
     • Enter the minimum and maximum duration in minutes. 
   • Enter Code Modifiers - Modifiers provide additional information to payers to make sure the provider gets paid correctly for services rendered.
   • Units
     • Always Bill For - Does NOT look at the Appointment length. The Appointment will always be billed for the number of units in this box regardless of Appointment length. The number of units in the box, multiplied by the dollar amount entered in the Rate field (above) will be your invoice line item amount for that service.
     • Bill for 1 Unit - DOES look at the Appointment length. 
       You may select increments from 1 to 120 minutes. The amount billed for the session will be calculated using:
       Appointment Length in minutes/increment = Total Units
       Total Units x Rate = Invoice Amount
       
        NOTE: For service types that bill 1 unit for a certain time interval, units are calculated based on a mid-point rounding system. The calculated number of units will round up once the midpoint is reached, and round down if the midpoint is not reached based on the length of the appointment. The number of units will never round down to 0. For example:

       If the service type bills 1 unit for every 15 minutes, the midpoint is reached at 8 minutes

       • An appointment from 2:00 - 2:38 PM would round up to 3 units.
       • An appointment from 2:00 - 2:37 PM would round down to 2 units.

       If the service type bills 1 unit for every 60 minutes, the midpoint is reached at 30 minutes

       • An appointment from 2:00 - 3:30 PM would round up to 2 units.
       • An appointment from 2:00 - 2:29 PM would round down to 1 unit.
          
   • Select Applicable Positions - This allows you to limit what Staff Positions are able to schedule Appointments for this Service Type. Multiple positions can be selected.
   • Associate Pay Code Non-Billable Service Type which is used to calculate payroll based on the rate associated with the pay code.
   • Supervision Status - This allows you to classify Service Types as Supervision or Direct services. See Scheduling Supervision Appointments for more information.
     
      NOTE:  If Do not bill overlapping direct service type is checked in EDI file settings for your insurers, then you must also choose the appropriate Supervision Status of Supervision or Direct to ensure proper billing. If the status is set to none you will be unable to schedule supervision appointments. See Apex: Setup EDI File Settings for more information.
      
   • Create a Service Type Color Code (optional) - Select a background and text for the color of the Service Type. This is displayed on the Calendar view in each Appointment.
   • Exempt from Payroll - Set specific service types as being exempt from payroll so that they do not pull into the payroll report.
   • Click Prevent scheduling for service types without a valid authorization to prevent appointments from being scheduled for service types that do not have an authorization, or are associated with an authorization that is expired, exhausted, inactive, or does not have any available units.
   • Click the Save Service Type button.

[Back to Top]

Edit Billable Service Types

1. Click the Organization and Settings in the navigation bar.
2. Click the Billable Service Types tab and locate desired Service Type. 
3. Click the name of the Billable Service Type. The Edit Service Type window opens.
   
    NOTE:  You may search for service types by entering the desired text in the field at the top of a column. More than one column may be used to narrow the search.
   
   
    
4. Edit  information and click Save Service Type.
   
    IMPORTANT:  The service type will now be updated for all past and future appointments. If you do not wish to impact past appointments, archive the existing Service Type and create a new one with the updated information.
    

[Back to Top]