Service Codes

Information about Service Codes in Billing

Billing / Service Codes Create a Service Code

To create a new service code:

  1. Navigate to the Billing Module  and select Service Codes.
  2. Click the  Add New button at the top right hand-side of the page.
  3. Complete the Basics form:
    1. Type: defines the type of code. Select one:
      • Unknown
      • Billable
      • Non-billable
    2. Code: enter the code value, which will be the code sent on the claim.
    3. Description: enter the organization’s internal description of the code. This value is not sent on the claim and serves as an internal reference to easily know what the code is.
    4. Enforce Rate: first level of security to limit user access to the code. Select one:
      • Default rate can be used: every client and provider will be linked to the code and the billing rate will be the default entered.
      • Enforce custom provider rate: employees can submit timesheets with their custom rate for the code for any client within their network. If a client is not listed with a custom rate, it will charge the default rate.
      • Enforce custom client rate: the code can only be used for specific clients. Clients will be billed their custom code rate when the code is used by any provider within their network.
      • Enforce custom provider & client rate: the code can be used by specific providers for specific clients. Clients will be billed at their custom rate and providers can only charge their custom rate.
    5. Calculation type: tells the system how the code will work for billing and payroll purposes. Select one:
      • Bill by time/Pay by time: calculates the billed amount and the employee’s pay based on the amount of time on the timesheet. Does not round.
      • Bill by units/Pay by time: calculates the billed amount based on the number of units and the employee’s pay based on the amount of time on the timesheet.
      • Bill by units/Pay by units: Calculates the billed amount and the employee’s pay based on the number of units on the timesheet.
    6. Default Units: enter the number where the system must start counting when the code is used – 1, 15, 30, etc.
    7. Default Service Location: select the service location starting point.
    8. Minutes per Unit: enter how the system should count from 1 unit to 2 units, from 2 to 3, etc. If you have a flat-rate code, leave blank, and the system will default to 1. Additionally, select how to round up:
      • Round at halfway (default): defaults to rounding halfway.
      • Rounds past halfway (half + 1)
    9. Default Minutes: enter how many default minutes should this code fill in an appointment.
    10. Modifiers: enter suggested modifier groups for timesheet conversion, if any.
    11. Validation: complete this section to define the items that need to be completed on the timesheet whenever the code is used. For each validation, select: (1) Not needed if it should not be included in the timesheet (2) Optional if it should appear but would be an optional field to complete or (3) Required if it’s a required field to be completed.
      • Service Location: point of service physical location
      • Service Address: point of service address
      • Procedure Info: details about the procedure
      • Drive Time & Miles: total drive time and miles
      • Service Notes: 140 characters required to be filled out pertaining service notes
      • Admin Notes: 140 characters required to be filled out pertaining admin notes
      • Provider Signature: if the provider signature is required
      • Client Signature: if the client signature is required
      • Client Signature Form: if  the client signature form is required
    12. Restrictions: complete this section to set up additional code configuration.
      • Required authorization: will determine if the code must have an authorization before it can be used. If required, the code won’t be available unless there is an authorization available for the client, and nobody will be able to convert the code without an authorization. Select one:
        • Required
        • Optional
      • Enforce Single Timesheet Conversion: check for the code to only be converted once from the schedule. The restriction is bypassed by the organization account or users with permission to Manage > Timesheet Conversion, who will be able to convert more than once if the permission is enabled.
      • Requires Schedule Conversion: check to enforces the code to only be used and converted from a schedule. The restriction is bypassed by the organization account or users with permission to Manage > Timesheet Conversion, who will be able to convert outside of the schedule.
        • If checked, the code won’t be available to be used when adding a timesheet manually from the + Add New Timesheet section within the Billing Module 
      • Restrict Early Timesheet Conversion: check to restrict appointments with the code from being converted before the appointment actual start time. If enabled, no user can bypass this restriction.
      • Lock Grace Period: Enter to define how many days after the appointment date, the appointment must be converted before needing admin help. The restriction is bypassed by the organization account or users with permission to Manage > Timesheet Conversion, who will be able to convert passed the grace period.
    13. Misc
      • Show client rates: check for clients to view the rates of the service codes within their CentralReach account.
  4. Click the Note Templates tab to set up the templates  providers need to attach to the service code:
    1. Click the icon to add a new template.
    2. Enter the template name in the new field that appears.
    3. Click the drop-down to select whether you want the note to be Optional or Required.
  5. Click Save.

Once the code is created, it must have a fee schedule assign for the code to be used. To learn how to assign a fee schedule, click here. 

Billing / Service Codes Delete a Service Code

To delete a service code:

  1. Navigate to Billing Module and select Service Codes.
  2. Click the service code you wish to delete.
  3. Scroll down to the bottom of the page and click Delete.
  4. Click Yes if you are sure you want to delete this billing code.

Deleting a service code moves it to Deleted Service Codes. You can restore a deleted service code at any time.

To learn how to restore a service code, click here.

 

Billing / Service Codes Recover a Deleted Service Code

To recover deleted service codes:

  1. Navigate to Billing Module and select Service Codes.
  2. Click on the Active Service Codes  option on the top of the grid and select Deleted Service Codes.
  3. If you are recovering one service code:
    • Click the restore button under the Options column on the right hand-side of the code you wish to recover.
  4. If you are recovering multiple service codes:
    • Click the checkbox next to each code you wish to restore.
    • Click the Actions  option on the top of the page and select Undelete selected.
  5. Click Yes in the Confirm pop up.

 

Billing / Fee Schedules / Billing / Service Codes Add a Fee Schedule and Rate to a Service Code

Service Codes can be assigned to multiple Fee Schedules based on the agreed payor rates. Service Codes must have at least one fee schedule attached, otherwise, you will see a yellow warning  just to the left of the code. The default rate associated with the Fee Schedule is the rate an insurance company or private client will be billed for such service.

To assign Fee Schedule and a rate to a Service Code:

  1. Navigate to the $ Billing module and select Service Codes
  2. Click the cog  icon on the right of the code under the Options column, and select Add Default Rate
  3. Click the Fee Schedule  drop-down and select the Fee Schedule you are associating to the code
  4. Enter the Rate, which is the amount you are charging for a specific service
  5. Enter the Agreed Rate, which is the rate negotiated with the insurance payor for the service. If you do not have agreed rates you may enter the Rate used above.
  6. Click Add

Billing / Service Codes Add Custom Employee Rates to Service Codes Via Paycodes

Once you’ve created pay codes and assigned them to your employees, you can add multiple provider rates to your service codes in bulk. If you do so, an employee’s pay rate will be applied as their provider rate for those codes.

For example, employee “A” is assigned to pay code “BCBA” with a rate of $50. Now, if we add a custom rate to service code “H2014” using employee pay code “BCBA,” employee “A” will be paid $50 for any timesheets they submit using code “H2014.”

If employee “A” is also assigned to pay code “Admin” with a rate of $30 you can apply that pay code to your Admin service codes. This will allow you to pay providers different rates based on the type of work performed.

To add custom rates to a service code:

  1. Navigate to the $ Billing module and select Service Codes
  2. Click the checkbox next to each code you want to apply provider rates to
    • If you’ve assigned a label to those codes (e.g. “BCBA” or “Admin”), filter by that label and select all using the checkbox in the column header 
  3. Click the Actions  option on the top of the grid and select Add custom rates from paycodes
  4. Select Click to add paycodes  and select a paycode
    • Continue to click Click to add paycodes  to add more paycodes to the code
  5. Click Add

All employees with a pay rate for the selected paycodes will now have a provider rate set up for the selected service codes.

Note: You can only apply rates from paycodes when there isn’t a provider rate already set up. For codes with an existing provider rate you will need to use the update rates as the selected option.

Billing / Service Codes Edit a Service Code

To edit a service code:

  1. Navigate to the Billing Module  and select Service Codes.
  2. Click the service code you wish to edit under the ID column.
  3. Edit the code details as needed.
  4. Click Save.

Notes & Forms / Notes & Forms Templates / Billing / Service Codes Link a Note Template to a Service Code

For providers to add clinical notes to their timesheets, you first need to link note templates to your service codes.

To link a note template to a single service code:

  1. Navigate to the  Billing module and select Service Codes
  2. Click on the service code you want to link to a note template
  3. Click the Note Templates tab
  4. Click the icon on the top right side to add a new template
  5. Enter the template name in the new field that appears
  6. Click the drop-down to select:
    • Optional: if it’s not mandatory to fill out the note to submit the timesheet
    • Required: if it’s mandatory to fill out the note to submit the timesheet
  7. Click Save

To link a note template to one or more service codes in bulk:

  1. Navigate to  Billing module and select Service Codes
  2. Click the checkbox  on the left hand-side of the service codes you want to link to a note template
  3. Click Actions  on top of the grid and select Add a notes template to selected
  4. Enter the template name
  5. Click the drop-down to select:
    • Optional: if it’s not mandatory to fill out the note to submit the timesheet
    • Required: if it’s mandatory to fill out the note to submit the timesheet
  6. Click Add

Billing / Service Codes Add Employee or Client Rate to a Service Code Individually

To add or update the provider and/or client rate of one or multiple service codes individually:

  1. Navigate to the $ Billing module and select Service Codes
  2. Click the checkbox  icon next to the service codes you wish to add custom rates to
  3. Click the Actions button on the top of the grid and select Update rates for selected

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4. Complete the Bulk update custom rates form:

  • Client: if you are updating a client rate, enter the client name
  • Client Rate: enter the client rate
  • Employee: if you are updating an employee rate, enter the employee name
  • Employee rate: enter the employee rate.
    • Add their hourly rate if the code is set to Pay by time
    • If the employee is salaried, add $0 for Employee rate.
  • Click Update rates

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Once you’ve added the rates, the code will be available to be used by that particular employee.

To learn how to add multiple employees to multiple service codes via paycodes, click here.

Billing / Service Codes Add Service Code Modifiers or Group Modifiers

 

To add a service code modifier to a service code:

  1. Navigate to the Billing Module and select Service Codes.
  2. Click on the service code you want to add optional modifiers to.
  3. Next to the Modifiers section add your modifiers.
  4. Click Save.

To add a new modifier group:

  1. Navigate to the Billing Module and select Service Codes.
  2. Click the Fee Schedule Rates option on the top of the grid.
  3. Click the Settings  icon to the right of the code under the Options column, and select Add Modifier Group.
  4. Complete the Add New Modifier Group form:
    • Name: enter the modifier name.
    • Location: select the location from the drop-down.
    • Rate: enter the amount you are charging for the service.
    • Agreed Rate: enter the rate negotiated with the insurance payor for the service. If you do not have agreed rates, enter the Rate used above.
    • Click Add.

Once set up, these modifiers will automatically apply to any timesheets using this fee schedule/service code combination.

To learn how to edit a modifier, click here.

Billing / Service Codes How to Edit a Modifier

To edit a service code modifier:

  1. Navigate to the Billing Module and select Service Codes.
  2. Click the Fee Schedule Rates option on the top of the grid.
  3. Search the fee schedule you wish to edit, and update the correspondent modifier information. View image here.
  4. Click Save Changes on the top of the screen.

Billing / Service Codes Update Service Code Rates in Bulk

You can add or update service code rates in bulk for many employees. You might find this useful for your non-billable codes. For example, you may have an administrative service code for meetings, where all employees get paid a rate of $12/hour.

To update service code rates in bulk:

  1. Navigate to the Billing Module and select Service Codes.
  2. Click the Custom Rates option on the top of the grid.
  3. Enter the service code name on the top search bar to filter the service code.
  4. Enter the new rate under the Employee rate column and hover over to the left of the employee rate and click the double arrow icon that appears to set the provider rate for all the entries filtered.
  5. Click Yes in the Confirm pop up to set up the rate for all the employees for the entries selected.

update rates5

Billing / Service Codes Set Up Unpaid Service Codes

To track unpaid time, you can create unpaid service codes for your organization.  This allows you to report on activities such as lunch breaks.

To create an unpaid service code:

  1. Navigate to the Billing Module  and select Service Codes.
  2. Click the  Add New button at the top right hand-side of the page.
  3. Complete the form with following details:
    1. Code: enter the code value.
    2. Description: enter the organization’s internal description of the code.
    3. Enforce Rate:
      1. Select Default rate can be used if any employee will be able to use the code.
      2. Select Enforce custom provider rate to restrict the code to only some employees.
    4. Go to the bottom of the form, Restrictions:
      1. Click Requires Authorization and select Optional since you won’t be using an authorization with this code.
  4. Click the Save.

After creating the unpaid code, you would then need to add a $0 rate for each employee who will use this code.

Billing / Service Codes Set the Default Minutes on a Service Code

You can define the amount of time to be added to an appointment for a specific service code. This is done by setting up the Default Minutes field within a service code’s settings.

To edit a service code with default minutes:

  1. Navigate to the Billing Module  and select Service Codes.
  2. Click on the service code you want to edit.
  3. Go to Default Minutes and enter how many minutes should this code fill in an appointment.
  4. Click Save.

Once the default minutes are set up, any codes that are set up a with a default length will automatically adjust to the default minutes, regardless of the entire appointment length.

 

Billing / Service Codes Set Service Code Rounding Rules

You can set up rounding rules for service codes.

To edit a code rounding rules:

  1. Navigate to the Billing Module  and select Service Codes.
  2. Click on the service code you want to edit.
  3. To the right of Minutes per Unit click the drop-down and select:
    • Round at halfway (default): This means that once the time gets to exactly half of the Minutes per Unit value, the system will round the unit up.  For example, if you have a 30-minute unit and there is an entry that is 15 minutes then the unit will show as one. If the entry is 14 minutes then the system will round this down to 0 units.
    • Round past halfway (half + 1): This means that the system will round the units up once the entry is half of the Minutes per Unit plus 1 minute. So in the above scenario the 15-minute entry would round down to 0. Once the entry gets to 16 minutes then it would round up to 1 unit.
  4. Click Save.

Note that all newly created codes will default to Round at halfway (default).

Billing / Service Codes Set a Service Code to Require an Authorization

Some service codes require an authorization before they can be used to bill clients. To always requiere an authorization for a service code and prevent a service code from being used without an authorization, set up the code to always require an authorization.

To edit a service code to require an authorization:

  1. Navigate to the Billing Module  and select Service Codes.
  2. Click on the service code you want to edit.
  3. Go to the Restrictions section on the bottom of the form.
  4. Under the Requires Authorization section, click the drop-down and select Required.
  5. Click Save.

Billing / Service Codes Provider or Client Signature Requirements

Within each service code’s settings, you can choose whether or not to collect a signature for the timesheet to be converted.

To edit a service code signature requierements:

  1. Navigate to the Billing Module  and select Service Codes.
  2. Click on the service code you want to edit.
  3. Scroll down to the Validation section and go to the Provider Signature and Client Signature drop-downs.
  4. For each drop-down, select one of the following:
    • Not Needed: timesheets converted using this code will have the signature field removed.
    • Optional: timesheets converted using this code will include an optional signature field.
    • Required: timesheets converted using this code will include a required signature field.
  5. If you set the client signature to required, another field called Client Signature from will appear. Select whether you want clients to be able to sign only from the provider account, their client account, or either.
  6. Click Save.

Billing / Service Codes Set Up Grace Period to Service Codes

Within each service code, you can define the grace period employees have to submit a timesheet after the appointment ends. 

For example, if an appointment has a service code with a grace period of 7 days, that employee has 7 days from the date of the appointment to convert to a timesheet. Once the 7 days have passed at UTC midnight, the employee won’t be able to convert the appointment unless he/she has the Billing > Manage Timesheets permission enabled. 

To set a grace period for a service code:

  1. Navigate to the $ Billing module and select Service Codes
  2. Click on the service code you want to edit
  3. Scroll down to the Restrictions section
  4. Go to Lock Grace Period and enter the number of days of the grace period
  5. Click Save

To convert an appointment past the grace period, the organization’s account or a user with the proper permission rights would have to convert the appointment on behalf of the employee. Alternatively, the service code grace period can be temporarily removed or extended so the employee can convert the appointment. If so, the grace period would need to be updated back to its original value after the appointment is converted.

Billing / Service Codes Set Up a Flat Rate Service Code

For services that need to be paid at a flat rate, regardless of how much time is taken to complete the service, we recommend setting up your code as “Bill by units, Pay by time.” 

To update a code to bill as a flat rate:

  1. Navigate to the $ Billing module and select Service Codes
  2. Click on the service code you want to edit
  3. Click the Calculation Type drop-down and select Bill by units / Pay by time

4. Go to Default Units, and enter the units. Please note, if the payor requires you to bill by a certain unit (i.e. 2 units) then default to the requirements as outlined by your payor

5.  Go to Minutes per Unit and ensure it is blank

6. Click Save