Service Codes

Information about Service Codes in Billing

Billing / Service Codes Add a Fee Schedule to a Service Code

The default rate associated with a fee schedule is the rate an insurance company or private client will be billed. Before you can use a service code, it must have at least one fee schedule attached. If a service code does not have a fee schedule you will see a yellow warning  just to the left of the code. To add a fee schedule to a service code:

  1. Click on the Settings icon to the right of the code and select Add Default Rate.
  2. Select a Fee Schedule then add the Rate and Agreed Rate. If you do not have agreed rates, use the same value for both.
  3. Click Add.

Billing / Service Codes Add Custom Rates from Paycodes

Once you’ve created pay codes and assigned them to your employees, you can add multiple provider rates to your billing 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.

  1. Navigate to Billing  then click on 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  dropdown at the top of the page and select Add Custom Rates from Paycodes.
  4. Select Click to add paycodes and select as many paycodes as you like from the dropdown.
  5. Click Add.

All employees with a pay rate for the selected pay codes 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 selected option.

Billing / Service Codes Bill by and Pay by Settings

CentralReach lets you choose how you want to bill out your services. You can choose Bill by time/Pay by time, Bill by units/Pay by time, or Bill by units/Pay by units. To begin:

  1. Navigate to Billing  and select Service Codes.
  2. Click on the service code you wish to edit.
  3. Next to the Calculation Type dropdown, select one of the three options below.
    • 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.
  4. Click the Save button at the bottom of the page.

Please keep in mind that CentralReach rounds units based on two options. Round at halfway (default) or Round past halfway (half+1). Select the option needed for your payors.

Billing / Service Codes / Notes/Forms / Templates Connecting Note/Form Templates to Service Codes

In order to attach a Note/Form template to a service code you will need the Settings > Manage permission.

  1. Navigate to Billing then Service Codes.
  2. Select one or more codes by using check boxes .
  3. Click Actions then Add note templates from selected.
  4. Search for the note to be attached and choose whether it is Optional or Required.
    • Optional: appointment can be converted without this note.
    • Required: appointment may not be converted without adding this note.

 

 

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 form to configure the service code settings.
  4. Click Save.

You can delete a service code at any time.

Billing / Service Codes Delete a Service Code

To delete a service code:

  1. Navigate to Billing , then Service Codes.
  2. Click on the service code you wish to delete.
  3. Scroll down to the bottom of the page and click the Delete button.
  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 code at any time.

 

Billing / Service Codes Establish Default and Optional Modifiers

Once you’ve set up your service codes, you can create service code modifiers and modifier groups. The big difference between service code modifiers and modifier groups is that one allows modifiers to be manually added while the other automatically applies the chosen modifiers.

  • Service Code Modifier: a set of modifiers tied to a single code. These modifiers will be optional and have to be manually added to timesheets.
  • Modifier Group: a set of modifiers that are tied to a fee schedule. These modifiers will automatically be added to timesheets using this fee schedule and service code combination.

To set up a service code modifier:

  1. Navigate to Billing  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 Billing  and select Service Codes.
  2. ClickFee Schedule Rates at the top of the page.
  3. To the right of any fee schedule, click the Options  button.
  4. In the dropdown, select Add Modifier Group.
  5. Give the new modifier group a Name, input your Modifiers, and input the Rate and Agreed rate. You can also optionally set a default location.
  6. When you’re finished, click Add.

These modifiers will now automatically apply to any timesheets using this fee schedule/service code combination.

If you need to edit any of your existing modifiers, click on the modifier  from the Fee Schedule Rates page.

 

 

Billing / Service Codes How do I add a custom provider rate?

Under service code properties, Enforce custom provider rate refers to the ability to restrict certain users from being able to use this code. This is the default setting that will be pre-selected when adding a new service code as the best-practice is adding only certain users to certain codes (e.g. linking only RBTs to RBT service codes).

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To add a new custom provider rate to a billing code or multiple codes, click on Services Codes under the Billing & Timesheets module ($ icon). Find the code(s) for which you wish to add the custom rate to and check the box to its left, select Actions and click Update rates for selected.

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Then add the employee, and their hourly rate if the code is set to Pay by time. If the employee is salaried, add $0 for Employee rate. Add the employee name, rate, and click Update rates. (No need to enter a client as their billed rate will pull from the default fee schedule rate on the service code).

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Once you’ve added the rates, the code will be available to be used by that particular employee. To add multiple employees to multiple service codes via pay codes click here.

Updated: 3/27/2017

Billing / Service Codes How do I bulk add a rate for an employee and/or a client?

To Bulk add/insert a rate for an employee (pay code) and/or a client (charge rate), navigate to Billing > Service Codes.

To add a custom rate for an employee (pay or just to link an employee to a service code)

If bulk adding via paycodes select all service codes you want to add employee custom rates to > Actions > Add custom rates from paycodes.  Tip: If you label service codes by job title you can filter the service code screen so that only service codes that you would want a specific type of employee to have access to.  adding rates to service codes help article 1Choose the desired paycode from the drop down and click Add For information on how to set up paycodes go here.

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To add an individual custom rate to one service code for one employee and/or client (billed rate) you can click on the gear icon under the Options column on the rights side of the service codes screen and select Add custom Rate

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You can also update existing rates (i.e. in event staff received a raise) by selecting the service codes you want to update a contacts rates for > actions > update rates for selected.

 

The only way to update an existing rate is through the Update existing rate function.  Add new rate will not override the current rate if one exists.

Billing / Service Codes How do I change client or provider rate?

To change a client or provider rate, navigate to $ > Service Codes:

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If you are changing the rate for a specific contact, search by their name at the top of the screen:

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Select the service you want to update by checking the boxes to the left hand side. Once you have done that, go to Actions > Update rates for selected:

 

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If you are updating rates for a client, you will use the top two boxes to enter in the client’s name and their new charge rate. If you are updating rates for a employee, you will use the bottom two boxes to enter in the employee’s name and their new pay rate. In this example, we are updating our employee’s hourly rate to $17 per hour:

 

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Once you are done, click on Update rates. You can also update rates in bulk for many employees for a code. You might find this useful for your non-billable codes. For example, you may have an administrative for for Meetings, and everyone gets paid a new rate of $12/hour when attending meetings. To do this, search for your code and then go to Custom Rates:

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Then enter in the new rate for the top employee, hit the arrows next to their name to apply the rate to everyone below:

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Billing / Service Codes How do I know what ‘Enforce Custom Provider and Client rate’ means?

‘Enforce Custom Provider and Client Rate’ means that you charge individual clients different rates for a code AND you pay your providers a different rate per client for the same code. Use this code if you charge a different client rate for each client for the same service and you pay your providers a different rate for the same code.*

 

*Example: Child A and Child B are being charged a different rate for the same service and Provider A and Provider B are getting paid separate rates to provide the same service.

 

Billing / Service Codes How do I set a grace period for converting an appointment?

Within each service code’s setting, you can decide whether you want to “lock grace period.” With the grace period setting active, administrators can specify how long an employee has to submit a time sheet for an appointment using a particular service code.

For example, if an employee adds a billing code with a grace period of 7 days to an appointment, that employee then 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 must request access for late changes/submission.

To do this, first navigate to Billing > Service Codes then click on the service code you want to edit.

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Then, scroll down to where it says “lock grace period” and add a value (in days). Click Save when you are done.

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Billing / Service Codes How do I set up a code for flat rate services?

For services that need to be paid at a flat rate, regardless of how much time is taken to complete that service, we recommend setting up your code as “Bill by units, Pay by time.”  To begin, click on the billing icon and select Service Codes from the drop-down menu.


 

Select a code you want to use by clicking on it.  In the Basics tab, you will see the Calculation type field. Select the Bill by units, pay by time option from the drop-down menu.

Then, enter your Default units, which will usually be set to ‘1’ as the default. (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). When done, click Save.

Billing / Service Codes How do I set up and enforce codes and rates?

To manage Codes & Rates first select ‘service codes’ from the Billing Module.

Select the Actions drop down and click on “Add a new service code”  to add a code or rate.

In the pop up box that appears, enter the code related to the service as well as a description e.g. H2019/Behavior therapy. *Note: Do not click on the save button until you have made  the necessary modifications to all tabs.

Enter the Code and a description in the appropriate boxes. In the Enforce rate box four options can be selected.

  • Default rate can be used – Every client and provider is linked to the code. The rate billed will be the Default rate entered in the next box.
    • As this is a default rate, there is no need to connect every employee to a code individually through the ‘custom rate’ feature. This is the preferred way to quickly connect all employees to a code.
  • Enforce custom provider rate – Employees can submit timesheets with their custom rate for the code to use for any client within their network. If a client is not listed with a custom rate, it will charge the default rate
    • Clients will be billed for the default rate established for the fee schedule. Use this code if you are billing all of your clients the same rate for the fee schedule associated with this code, but you are paying your providers different rates for providing the service. Here’s how to add a custom provider rate to a service code: Adding a custom provider rate
  • Enforce custom client rate – Clients will be billed with their custom rate to the code to be used with any provider within their network.
    • Each client is charged a different amount for the service. Using this setting also means that you are not associating any rate with your providers. Use this rate if you charge individual clients different rates for a particular service code AND you do not wish for CentralReach to calculate pay rates for your providers.
  • Enforce custom provider & client rate – Clients will be billed at their custom rate and providers can only charge their custom rate.
    • Each client is charged different rates for a code AND you pay your providers a different rate per client for the same code. Use this code if you charge a different client rate for each client for the same service and you pay your providers a different rate for the same code.
    • *Example: Child A and Child B are being charged a different rate for the same service and Provider A and Provider B are getting paid separate rates to provide the same service.

Enter the minutes per unit and think click on the validation section.

Within the Validation section you have the option to “require”, “make optional”, or “not needed” several items on the timesheet.  Any items that are selected as required will need to be completed before an employee can convert their timesheet.  When you are finished editing, click the Save button.

The new code/rate schedule will appear at the top of the current code/rate list. You can add a label to the code by clicking on the box on the same line as the code. The click the label button and select the label(s) that you wish to add to the code. To add a new label that is not listed in the default label list, click on Manage labels and create a new label. When you are finished, click apply.

Billing / Service Codes How do I view and edit my authorization settings?

The Authorizations module handles more than traditional ‘insurance authorizations’.  Users can store and create authorizations for any contract service that requires time tracking (i.e. school contracts, staff training hours, private payor services).  This provides an excellent way to track time, collect data, and easily report information to not only payors; but supervisors, parents and other stakeholders.  In addition, authorizations allow organizations to restrict billing and determine how codes are used by staff.

In determining how to use authorizations, there are a series of questions you need to answer.

1. Do you want to restrict billing?  

Do you want to control what codes your staff have access to when submitting timesheets?  99.9% of companies answer – “Yes, we want to restrict billing.

In that case, the first step is to set your service codes to require an authorization using a default service code setting.

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This will ensure a service code can only be billed by a staff if the date of service falls within a matching authorization’s start-end date.  This will not yet enforce that a specific provider be authorized for that service.  In other words, anyone in the company can use the service code to bill assuming there is a valid authorization on file.

*Best practice recommendation – Set service codes to default and requiring authorizations.  This will create ‘Open authorizations’ that any provider can bill against if there timesheet falls in the date range of the authorization.

2. Do you want to lock down billing further to only allow specified providers to see codes? 

There are two options for restricting service code use by staff:

Option A – Restrict use at the authorization level using a ‘Provider Specific’ authorization. 

In the Contacts section of the authorization, specific providers can be assigned for use.  Once locked to a provider, the authorization is no longer considered “open.”  In addition, it automatically inserts the default client and provider pay rate for that service code without the need to visit billing settings.

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Option B – Restrict use at the service code level using ‘Enforcement’ settings (not Default rate). 

Open authorizations are not specific to any single provider and all employees connected to the relevant client can use this authorization to bill assuming they have code access.  Setting your codes to an enforce rate other than Default rate can be used will require that a specific rate be set with that client or provider before use. Click here to learn more about enforce rates.

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*Best practice recommendation – Restricting at the authorization level using provider specific authorizations has less manual entry.  In the situation where, there are situations where the client is charged or staff paid something different from default, then option 2 would be ideal.

Please review the help articles in Authorizations Setup to learn more about how to get started.

Billing / Service Codes Link a Note Template to a Service Code

If you’d like providers to add notes/forms to their timesheets you’ll first need to attach note templates to your service codes. To add a note template to a single service code:

  1. Navigate to Billing  and select Service Codes.
  2. Click on any service code.
  3. Click on the Note Templates tab.
  4. Click the to add a new template.
  5. Search for and select the template you wish to attach.
  6. Choose whether you want the note to be optional or required.
  7. Click Save.

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

  1. Navigate to Billing  and select Service Codes.
  2. Click on the checkbox  next to any of your service codes.
  3. Click on the Actions  button at the top of the page and select Add a notes template to selected.
  4. Search for and select the template you wish to attach.
  5. Choose whether you want the note to be optional or required.
  6. Click Add.

Please keep in mind that setting a note to Required means providers will have to add that note to any timesheets they convert with that code.

Billing / Service Codes Provider or Client Signature Requirements

Within each service code’s settings, you can choose whether or not you’d like to collect a signature when a timesheet is converted.

  1. Navigate to Billing  and select Service Codes.
  2. Click on any of your service codes to edit it’s settings.
  3. Scroll down to the Provider Signature and Client Signature dropdowns.
  4. From each dropdown, select Not NeededOptional, or Required.
    • 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. Choose whether you want clients to be able to sign only from the provider account, their client account, or either.
  6. When you’re finished, click Save.

Billing / Service Codes Recover a Deleted Service Code

If you deleted one or more service codes by mistake, you can recover them in one of the following two ways.

To recover a single deleted service code:

  1. Navigate to Billing , then Service Codes.
  2. Click on the Active Service Codes button and select Deleted Service Codes.
  3. Click the restore  button next to the code you wish to un-delete.

To recover deleted service codes in bulk:

  1. Repeat steps one and two above.
  2. Click the checkbox next to each code you wish to restore.
  3. Select the Actions dropdown menu and click Undelete selected.

 

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 prevent a service code from being used without an authorization:

  1. Navigate to Billing  and select Service Codes.
  2. On the service codes page, click on the service code you wish to edit and scroll down to where it says Requires Authorization.
  3. From here you can choose Optional or Required.
  4. Once you’re done, click Save.

Billing / Service Codes Set Service Code Rounding Rules

CentralReach allows you to set your rounding rules at the service code level.  To set this rule:

  1. Navigate to Billing  and select Service Codes.
  2. Click on the service code you want to edit.
  3. To the right of Minutes per Unit click the dropdown and select Round at halfway (default) or Round past halfway (half + 1).
    • Round at halfway (default): This means that once the time gets to exactly half of the Minutes per Unit then 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.

All newly created codes will default to Round at halfway.

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

You can automate the amount of time automatically allotted to a specific service code when scheduling. This is done by setting up the Default Minutes field within a service code’s settings.

  1. Navigate to Billing  and select Service Codes.
  2. Click on the service code you want to edit.
  3. To the right of Default Minutes enter a value.
  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 Setting up Unpaid Billing Codes

You can track unpaid time by setting up unpaid service codes for your organization.  This allows you to report on activities such as lunch breaks. To get started:

  1. Navigate to Billing , then click Service Codes.
  2. Click the  Add New button to add a new service code.
  3. Give the code a name and change Enforce Rate to “Default rate can be used” if you want anyone to be able to use the code.
  4. Change Requires Authorization to “Optional,” since you won’t be using an authorization with this code.
  5. Click the Save or Save and add another button when you’re done.

If you only want certain users to have access to this code you can set Enforce Rate to “Enforce custom provider rate.” You would then need to add a $0 rate for each employee who should be able to use this code.

Now the code is ready to be used by employees for unpaid activities. If you want this code/time excluded from payroll, please follow this guide.

Billing / Service Codes What does “Default rate can be used” mean on a service code?

Selecting the enforce rate of Default Rate can be used means that any employee within the organization can use that code. As a result, any client can be billed against that code according to the default fee schedule. This is not advised for billable service codes and we recommend that this be an option for non-billable codes such as for codes reserved for administrative purposes.

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Last updated: 3/27/2017

Billing / Service Codes What is a fee schedule default rate?

The default rate associated with a fee schedule applies to the rate an insurance company / private client will be billed for a particular service code. If some clients are being charged different rates for the same code, then Enforce custom client rate or Enforce custom provider and client rate should be used.

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Click here to add one or more default fee schedules to a service code.

Last updated: 3/27/2017