Service Codes

Information about Service Codes in Billing

Billing / Service Codes Bill By and Pay By Settings

When creating a service code, set up a Calculation Type that will define how you want to bill and pay for services. This setting can be edited after the service code is created, if needed. 

Choose one of the following:

  • 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.

Click here to learn how to create a service code.

Billing / Service Codes Enforce Rate in a Service Code

The Enforce Rate in the Service Codes grid is the first level of security to limit user access to the code. There are four types of rates that can be assigned to a service code:

  1. Default Rate can be used: any employee in the organization can use the 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.
    • 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 connect all employees to a code.
  2. Enforce custom provider rate: employees can submit timesheets with their custom rate for the code and can use the code for any client in their network. If a client is not listed with a custom rate, it will charge the default rate
    • Use this code if you are billing all of your clients the same rate for the fee schedule associated with this code, but are paying your providers different rates for providing the service. Click here to learn how to add a custom provider rate to a service code.
  3. Enforce custom client rate: clients will be billed with their custom rate to the code to be used with any provider in 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 want CentralReach to calculate pay rates for your providers.
  4. Enforce Custom Provider and Client Rate: charge individual clients different rates for a code AND 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 pay your providers a different rate for the same code. *Clients will be billed at their custom rate and providers can only charge their custom rate.
      • E.g. 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.

Click here to learn how to create a service code.

Billing / Service Codes How to View and Edit Authorization Settings

Authorizations handle more than traditional ‘insurance authorizations.’ Users can store and create authorizations for any contract service that requires time tracking (E.g. school contracts, staff training hours, private payor services). This provides a way to track time, collect data, and easily report information to not only payors, but supervisors, parents, and other stakeholders. Authorizations also 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.

This will ensure a service code can only be billed by 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 their 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 used 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.

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.

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

Billing / Service Codes Service Code Modifiers and Modifier Groups

Service codes can have a service code modifier or group modifiers set up:

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

Click here to learn how to create a service code.

Click here to learn how to edit a service code with modifiers.

Billing / Service Codes Service Codes

Service codes are billable and non-billable codes that employees use when creating timesheets, and work in conjunction with client authorizations to track hours worked, hours scheduled, and hours remaining in a valid authorization. Employees must be linked to services codes in order to bill for services rendered. Billable codes are sent to funding sources for reimbursement and non-billable codes are used to calculate payable time that will not be reimbursed from a funding source.

Click here to learn how to create a service code.

Billing / Fee Schedules / Billing / Service Codes The Defaults Column in the Service Codes Grid

The “Defaults” column in the Service Codes grid displays the number of fee schedule rates associated with the service code.

When clicking over the value under the default column, you will be redirected to view the fee schedules attached to the service code and their corresponding Rate and Agreed Rate. A service code can have multiple fee schedules attached.

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Click here to learn more about the difference between Rate and Agreed Rate.
Click here to learn how to create a fee schedule.

Billing / Service Codes Understanding the Service Codes Grid

When navigating to the “Service Codes” section of the Billing module, you can create all of your codes and access a grid with all of the service codes set up for the organization.

Top Options:

  • Active Service Codes: the default grid view, displaying all active service codes. Clicking the drop-down will give the option to select Deleted Service Codes, to view and access all deleted services codes and to recover the codes
  • Fee Schedule Rates: all of the fee schedules set up for all of your active codes, along with the code modifiers, start date, end date, rate, and agreed rate
  • Custom Rates: all employee and client rates for all of the active service codes
  • Actions : a drop-down to perform the following actions:
    • Add new service code: add a new service code. This option is the same as the + Add New button on the top left-hand side of the screen
    • Update rates for selected: bulk add client rates and employee rates to service codes
    • Labels selected: add and remove labels from service codes
    • Add notes templates to selected: bulk add note templates to service codes
    • Delete note templates from selected: bulk delete note templates from service codes
    • Add custom rates from paycodes: bulk add custom employee rates from paycodes

Grid columns: All of the titles can be clicked to sort and filter codes based on options selected.

  • Checkbox: select multiple service codes to edit them in bulk through the options available under Actions  on the top of the grid
  • ID : service code ID assigned by the system. Click to edit the code settings
  • Defaults : total number of fee schedules associated to a code. When clicking, you will be redirected to the “Fee Schedule Rates” page for that code
  • Rates : total number of clients or employees linked to the code. When clicking, you will be redirected to the “Custom Rates” page for that code
  • Labels : total number of labels associated to the code. When clicking, you can view existing labels and add and remove labels from the code
  • Description : includes the service code and its description. The portion to the left of the colon is the code that is sent on the claim. The portion to the right of the colon is the description you assigned to identify the code and is not sent on the claim
  • Code Type : code type assigned to the code when it was created
  • Options: drop-down menu with the following options:
    • Edit Code Properties: edit the code settings, as if clicking the code ID in the grid
    • Add Default Rate: add a fee schedule and a default rate to the code
    • Add Custom Rate: add employee and/or client custom rates to the code
    • View x Default Rate: access all of the fee schedules associated to a code, as if clicking the defaults number in the grid
    • View x Custom Rates: access all of the client and employee rates linked to the code, as if clicking the rates number in the grid

Click here to learn how to create a service code.

Click here to learn how to download the Service Codes report.

Billing / Service Codes Usage Restrictions for a Service Code

In an authorization, usage restrictions can be set for a service code.

  • Once per day: the client can only receive services with that code once per day.
  • Once per day/provider: if the client receives services from multiple providers, the providers can use that code only once per day.
    • i.e. The code can be used more than once per day, but the same provider cannot use the code more than once.

The “Min Minutes” and “Max Minutes” are not a daily limit. For example, if “Min Minutes” is 30 minutes and “Max Minutes” is 60 minutes, one appointment for that code cannot be less 30 or more than 60 minutes.

  • Therefore, you cannot have 3 appointments for 30 minutes each, equaling 90 minutes, because it will not stop the employee from converting. This is a per appointment usage and not a daily usage.

Billing / Service Codes Using a Service Code Across Payors

The same service code can be used across payors, as long as the service code units and minutes are the same for all of the payors. For example, if code H2030 is a 15 minute code with payor A and the same code is 30 minutes for payor B, two service codes must be created in CentralReach for each payor, even if the code itself is the same. To differentiate one code from the other, assign a different description to each code when creating it.