Background
Many payers have different requirements for billing on admission and discharge days. Traditionally, Ritten will create billable services for encounters that occur after that admission time and before the discharge time. Now, you have the flexibility to decide exactly how those days are billed.
Additionally, some kind of encounter was needed for every day in a client's episode of care in order to generate all of the required billable services. Now, you can use the autogenerate function to automatically create billable services for days where the client is in an active program.
The four admit/discharge settings are:
Bill using service time - this is the existing standard. A billable service is only created if the encounter start time is between the exact admit/discharge times
Bill for admit/discharge day - even if the encounter is before admission or after discharge, a billable encounter will still be generated on that day. This is useful for providers who conduct billable assessments in the morning, but do not formally admit the client until the afternoon.
Do not bill for admit/discharge day - no matter time the encounter occurs, no billable service will be generated on that day. This is useful for payers who have specific rules that admission or discharge days are not billable.
Bill if admitted before time / Bill if discharged time - Ritten will only look at the time of admission to determine if any encounters that day are billed. For example, if the rule is set to "Bill if admitted before 3pm, the client is admitted at noon and has an assessment encounter at 11am, a billable service will be generated.
There is also an autogeneration setting: "Auto-generate services for active clients". When checked, Ritten will look at every active client every night and create a billable service if that client matches the program and payer inputs of the billing rule. This is helpful to make sure that every day of service is billed, regardless of what information is entered into the EMR every day. The autogeneration will abide by the same rules as the admit/discharge settings.
Frequently Asked Questions
How do I start billing a client when they are admitted, without creating an encounter?
Billing can be based off of an encounter or a client's enrollment in a program. To base it off of an enrollment in a program, the applicable program's service rule must be bundled.
By enabling bundling on the service rule, advanced options for Bill on Admit and Bill for Discharge become available. This enables per-diem billing configuration.
I configured the service rule and enabled bundling, but nothing shows up in billing once the client is admitted. Why is that?
The service rule runs each night at midnight. If the admission date is today, look tomorrow for the auto-generated service.
(In Patient) I tried adding a client to a bed, why is that client not showing up in billing?
Billing is not tied to bed occupancy, rather the program admission/discharge events are (see above).