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rdmoore2003:
Our office recently went to a new EMR/Billing program that is cloud based. As I am still in the learning process, I have come across more than 1 issue with this program. Apparently, the program can multiply but cannot divide. We bill $150 per unit of testing. Our tests range from a half unit to 2 units. For example, if I bill cpt code 96101 for 3 units at $150 per unit. The system multiplies correctly to bill $450. Now, I cannot bill a half unit, so it goes out as 1 unit but at half the amount, which is $75.00. This is where this program cannot divide. So, in speaking with the support department, I have been notified that this program can be "Bill for 1 unit for every ____ spent on this service during a single session" In the blank, the options are 15 minutes, 30 minutes, 45 minutes, 1 hour, 75 minutes, 90 minutes, or 2 hours. The only way to get the program to recognized a "half unit = $75.00" is to set the blank area to 30 minutes. My concern is that by doing this, it doubles the units. So if I am billing for say 4 units (one of these units are actually half a unit with charge of $75 and not $150), it doubles the units to 8 since it is in 30 minute intervals and not 4 (hourly units). Does this sound correct? I do not think it does. I have coded and billed for 13+ years and have never seen a program like this. My concern is more on the authorizations on some insurances will not process correctly if it is billed this way, because if we have authorization for 4 units and at the 30 minute interval, it will show correct charged amount but will show 8 units and not 4 units. PLEASE HELP!
Michele:
The description of 96101 indicates "per hour" so it does not seem correct to bill for 4 hours with 8 in the units. But since the description indicates "per hour" should you be billing in 1/2 hour increments? Wouldn't you round the time?
rdmoore2003:
Michelle,
This is my dilemma. With changing the settings to 30 minutes, the system multiplies the units. My main concern is for authorizations. If authorizations are for say 3 units, and if I change to 30 minutes, the system doubles the 3 units to 6 units because of the time increments. This new system automatically sets the units, it does not give the option to manually change the units.
Michele:
--- Quote from: rdmoore2003 on May 27, 2016, 03:52:24 PM ---Michelle,
This is my dilemma. With changing the settings to 30 minutes, the system multiplies the units. My main concern is for authorizations. If authorizations are for say 3 units, and if I change to 30 minutes, the system doubles the 3 units to 6 units because of the time increments. This new system automatically sets the units, it does not give the option to manually change the units.
--- End quote ---
But should you be billing in 30 minutes if the description is 1 hour? I'm thinking it should be set to 60 minutes. Your original post says you were trying to bill a 1/2 unit. I don't think you can bill a 1/2 unit can you? Aren't you supposed to round it to the nearest unit?
rdmoore2003:
--- Quote from: Michele on June 01, 2016, 09:59:27 AM ---
--- Quote from: rdmoore2003 on May 27, 2016, 03:52:24 PM ---Michelle,
This is my dilemma. With changing the settings to 30 minutes, the system multiplies the units. My main concern is for authorizations. If authorizations are for say 3 units, and if I change to 30 minutes, the system doubles the 3 units to 6 units because of the time increments. This new system automatically sets the units, it does not give the option to manually change the units.
--- End quote ---
But should you be billing in 30 minutes if the description is 1 hour? I'm thinking it should be set to 60 minutes. Your original post says you were trying to bill a 1/2 unit. I don't think you can bill a 1/2 unit can you? Aren't you supposed to round it to the nearest unit?
--- End quote ---
For 1 unit = $150.00 For 1/2 unit (it is billed for 1 unit but should divide the $150) = $75.00
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