Clinical Billing - Getting Started

From FMYiRCWiki

Jump to: navigation, search

Freemed-YiRC: Clinical Billing - Getting Started


Contents


[edit]

IMPORTANT NOTES

  • This guide is by no means complete! It is intended as a quick start guide for agencies who've already been in communication with myself and have been informed as to the status and limitations of the Freemed-YiRC clinical information and billing modules.
  • The Freemed-YiRC Ohio-Based MACSIS billing system works relatively well and has quite a few reports. It was originally developed for one agency, but as of the time of this writing (6/2009), it's being tested and phased in by three agencies for use in 2009.
  • The Freemed-YiRC utilities for insurance and private pay are really focused on the needs of one specific agency and will likely require modifications for other agencies to use.
  • Freemed-YiRC DOES NOT have a fully-featured insurance billing module. Freemed-YiRC CAN NOT directly bill insurance companies. The Freemed-YiRC insurance functionality is only intended to produce a cover sheet for use by 3rd-party insurance billing companies to bill.
  • If your agency wishes to use Freemed-YiRC for clinical billing and your agency does not intend to make any modifications to the system yourself, you should Contact Me directly for more information.


[edit]

Before You Get Started

  • Just because the Freemed-YiRC software has clinical billing functionality available doesn't mean your agency can just out-of-the-blue expect to begin performing clinical sessions and billing them. There is typically A LOT of initial set up, licensing, and/or accreditation required. In Ohio, this typically requires the involvement of the Ohio Department of Mental Health and/or Ohio Department of Alcohol and Drug Addiction Services.
  • Freemed-YiRC requires quite a bit of technical clinical information. This includes, but is not limited to, rates (dollar amounts) and service codes.


[edit]

Necessary Freemed-YiRC Modules

The following modules are required to be enabled in Freemed-YiRC for clinical billing. To do so:

  • Log in as the root user
  • Go down to the bottom of the main menu and click on Settings.
  • Go to the Module Manager section and click on Edit Module Settings.
  • Make sure the following are marked as Enabled:
    • Clinical Casenote System - This is where the actual clinical note data input is done.
    • Custom Forms System - This is the custom forms back-end system the Clinical Casenote System uses.
    • Medbill - This is the Freemed-YiRC medical billing system for billing notes created in the Clinical Casenote System.
  • The Clinical Casenote System is a group module. This means it is only accessed through a group menu. Hence, you must have this module enabled for use in at least one of your groups. To do so:
    • From the main menu, choose the Group Database (assuming your user has this permission, if not, try using the root user).
    • For the group, or groups, you wish to have enter clinical notes, click on the Modify link (must do one at a time).
    • Scroll down to the Permissions section of this page and mark the checkbox for the Clinical Casenote System, then hit the Update link on the bottom of the page.
    • You will need to repeat this process for each group you wish to enable this for.
  • In addition, your users will need to have the correct Security Database users permissions set up in the User Administration system.


[edit]

Adding Services

You must set up Freemed-YiRC with information about the clinical services you wish to input data for. This must be done regardless of whether you will bill for them or not... if your agency wants the data stored in Freemed-YiRC for a given clinical service type, then the following must be done.

  • From the main menu, find the CFS section. If you do not have this section on your main menu, this means you do not have the necessary permissions. Either add them (in User Administration in the Security Database for your user, in the Clinical Casenote Section), or use the root user.
  • Click on the Clinical Databases link in the CFS section.
  • There are quite a few menu options here. The primary one we want to focus on is the Clinical Services DB. Click on this link.
  • There may already be information in here. The stock version of Freemed-YiRC contains some commonly used clinical services. But these may vary for your agency, especially the rate fields (dollar amounts).
  • Look at this list. If your agency is not using one or more of these services, then delete those records.
  • If your agency is using one or more of these services, you will need to edit the records to ensure the information matches up. More information about the fields in these records is included in the following steps.
  • If you need to add a service, click on the Add Services link. Services must be added one at a time.


[edit]

Service Database Fields

There are quite a few fields for each service. Here is a breakdown of those fields and what they are used for.

  • Service: This is a descriptive label of the service name.
    • This should be something simple and should roughly match the name of the service for which you are licensed for.
    • For example:
      • Individual Counseling
      • Group Counseling
      • Medication/Somatic
      • Diagnostic or Diagnostic Assessment. Some even call this Mental Health Assessment.
      • Community Psychiatric Supportive Treatment (CPST) - Individual (may need to be abbreviated in order to fit).
  • Abbr: This is a short, descriptive, abbreviation to be used identification of a given service.
    • Most importantly, this abbreviation is used in all Freemed-YiRC invoice numbers for services.
    • Session Type: This indicates if this service is for Individual or Group use.
    • Rate: In Ohio, for MACSIS, this is used by Freemed-YiRC to indicate your agencies rate for this service.
      • THIS RATE IS THE HOURLY RATE - NOT THE UNIT RATE!!!
      • This number should not be made up, this number typically is provided by the oversight agency.
    • Old Code - This is a code used in Ohio used to identify this service. This is not the newer 837 code, this is the older code used by programs like MACSIS when the electronic HCFA-1500 was used for clinical billing. Even though this is not used today for billing, the guts of the Freemed-YiRC system still use this code for database linking purposes and is REQUIRED!
    • 837 Code - This is the new code used in Ohio (perhaps other states as well) to identify 837 HIPAA Procedure Codes for services.
      • Many of these codes start with H (for HCPCS) or M (for MACSIS) or 9 (for CPT).
      • Some (all?) of these codes are listed on this ODMH document: MACSIS - MH HIPAA Procedure Code Table (In the Type of Code column).
    • Rate Type - This is used to indicate if this is an hourly or 15 minute unit-based service. i.e., if the service is billed in hourly units or quarter-hourly units.
      • Some (all?) of these codes are listed on this ODMH document: MACSIS - MH HIPAA Procedure Code Table (In the Proposed time increment column).
        • Note: Freemed-YiRC, currently, only supports Hourly or 15 minute unit services. Others, such as Daily, Program Day, Monthly, or Variable are not supported and will not work in Freemed-YiRC!!!
    • 837 Modifier - This is used to indicate the HIPAA 837 modifier code for this service.
      • This is the code for the Modifier 1 field (i.e., the first modifier field). Typically, this will be HE for individual-oriented services or HQ for group-oriented services.
      • Some (all?) of these codes are listed on this ODMH document: MACSIS - MH HIPAA Modifier Code Table (In the Code column).
      • Note! Freemed-YiRC does not, currently, support any values for the second modifier code field (Modifier 2)!!!
        • Work is currently being planned on adding this functionality to support the Modifier 2 field, due for completion in 2H 2009.
    • Non Med Rate - This is a service billing rate used for Insurance or Private Payor billings (i.e., non-Medicaid).
      • This rate is typically higher and is also typically a rate devised by your agency.
[edit]

Other Related Information

There may be other information necessary to be set up in Freemed-YiRC. This information can also be found in the Clinical Databases link from the main menu in the CFS section.

There are several options here:

  • Clinical Services DB - This is covered in-depth in the above section(s).
  • Clinical Session Types DB - This should only contain Individual and Group.
    • Note! Do not modify this unless you are sure of what you are doing!
  • Place of Service (POS) DB - This is the list used for the Place of Service codes.
    • This code was mostly used in the older, HCFA-1500 MACSIS system. In the newer HIPAA 837 system these codes have been rolled up into two codes:
  • Diagnostic Codes DB - This is the list of billable diagnostic codes. This is an important list.
    • There is always some confusion when talking about diagnostic codes... confusion such as:
      • Do I use DSM-IV or ICD-9: I am not a clinical therapist, so I cannot directly answer this statement with 100% accuracy. However, it is my understanding that with the latest version of the DSM-IV and ICD-9 the codes mostly match.
      • How many codes can I use? This question is multi-faceted:
        • Freemed-YiRC allows you to associate an unlimited amount of diagnostic codes with a resident (via the Contact Database module for Residents).
        • Ohio MACSIS allows you to associate up to three diagnostic codes with a given billable service, hence Freemed-YiRC allows you associate up to three diagnostic codes with a given Clinical Casenote System note.
      • Why does Freemed-YiRC not include the entire list of codes by default? This is a fun question, with multiple answers:
        • Firstly, the list of DSM-IV codes is copyrighted and my understanding is that if I provided this list, not only would I have to pay for it, but I would have to provide a royalty back to the company responsible for the DSM. Because Freemed-YiRC is free, this is something of a problem.
        • Secondly, the list of ICD-9 codes, while supposedly open, is not available in an easily computer referenced, database-friendly manner. If someone finds updated information regarding this, and it's a FREE item, I would be happy to include it within Freemed-YiRC by default.
          • See [this CDC page] for more information. The codes are available in an RTF document, but not something like an excel or Comma Separated Values (CSV) file for easy import.
    • So, with the above information in-mind, my instructions to agencies are to enter this information manually. Typically, an agency will only use a small portion of the full DSM-IV or ICD-9 list. But keep in mind if you intend on billing MACSIS, you should only enter the MACSIS approved billable codes here!!!
      • Also, my advice to agencies is simply to enter new codes into the system when they are needed. i.e., when a new client enters your agency and is diagnosed with a specific code that doesn't exist in your Freemed-YiRC Diagnostic Code DB, enter it then.
  • Modifier Codes DB - This is the old list of MACSIS Modifier codes, pertaining to the old MACSIS HCFA-1500 billing.
  • Providers DB - This is a somewhat confusing item. At the agency for which the Freemed-YiRC clinical billing system was created for, certain billable clinical services were actually performed by staff external to that agency. However, the internal oversight staff name still needed to be assigned to the clinical notes themselves. Therefore, the Provider functionality was added. Using this functionality, you can link a note type to a list of providers, which could be internal or external people, who actually provided the service.
  • Clinical Casenote Design - This is a very important function and will be covered in-depth in another upcoming section in this document.


[edit]

Clinical Form Templates

Once you've got your clinical service information entered into Freemed-YiRC, it's then time to create your clinical form templates. Each service may have one (or more) form templates. Because Freemed-YiRC has the ability to create/import custom forms, you have the ability to tweak how these forms look... you are not stuck with the stock forms included in the system for your clinical notes.

[edit]

Important Considerations

  • The downside of manually creating form templates in Freemed-YiRC is that the process is somewhat painful, as this was one of the earliest modules created for the Freemed-YiRC system.
    • It is not user-friendly.
    • And to make matters worse, there is not currently a way to edit/modify an existing form in the system using the Freemed-YiRC user interface. Modifications must be done in the database itself.
    • Another method involves the use of exporting the design of a template to a text file, making the changes there, then importing that file as a new template in the system.
      • This is a recommended method when making substantial changes to a given form.
        • The reason being is that if you add or delete fields for a clinical form template that already has records created, the new template will apply to the existing records.
        • This means that if you go back to re-generate/print an existing record, the note will look different than the original one, which also means information may be lost!


[edit]

Important Concepts (READ THIS!!!)

These are very important concepts you need to read and understand regarding the clinical templates for clinical casenotes in Freemed-YiRC:

  • The NID: In the Freemed-YiRC Clinical CaseNote (CCN) you can have more than one data input/report template for each given type of clinical service (as listed in the Clinical Services DB). Therefore, each of these templates is assigned a NID.
    • NID stands for Note IDentifier.
  • You must have at least one NID for each clinical service you wish to do data input/reporting/billing for.
  • You can not use the same NID for more than one type of clinical service.
    • For example, you can not create one stripped-down/simplified NID template and use that for all clinical services under the guise of one NID.
    • You may, however, create a NID template, and import that template, multiple times, once for each clinical service.
  • Data on the template forms: The minimum amount of data a clinical note template may have is the set of fields which are required for billing. There is no maximum number of fields that can be included on a template, nor is there a maximum length for templates.
    • It is recommended, however, that data on these forms be focused on clinical items, and not be redundant data fields for information which can be stored in other places in Freemed-YiRC.
    • One big example of this is if your agency does Diagnostic Assessments. These forms can be quite lengthy and contain much information. For the purpose of a note template in Freemed-YiRC, some agencies simply choose to create a simplified/minimalistic note template. The rest of the information on the Diagnostic Assessment can go into other places in Freemed-YiRC. For example, demographics belong in the Freemed-YiRC Contact Database module. Other information belongs in the Emergency Info module.
  • Template form looks: One of the downsides of the Freemed-YiRC CFS/CCN template system is that the look of the templates is restricted due to the technology used. Typically, these template forms should contain only HTML with low use of images. Other technologies, such as CSS (Cascading Style Sheets) or Flash are not recommended. Currently, Freemed-YiRC does not support directly creating PDFs, except for creating HTML output, then converting it to PDF.
    • You can not, currently, create a template form in PDF and import that into Freemed-YiRC.


[edit]

Accessing the Clinical Forms Template Management/Administration Menu

The Clinical Forms Templates designs can be found by clicking the Clinical Databases menu link from the main menu, then by clicking on Clinical Casenote Design. If you do not one or more of these links then you do not have the appropriate security DB permissions.

On this menu you can manage the existing clinical forms templates, create new ones from scratch (Add new CCN Form), or import forms which were exported from other Freemed-YiRC systems, or those that have been included in the stock Freemed-YiRC distribution (Import CCN Form Design). Each of these functions is covered in-depth below.

[edit]

Managing Existing Templates

If you have any existing templates/NIDs in the system, they will be displayed on this menu. There are only several fields here, as well as some administrative options (depending on the security permissions your user has):

  • NID - This is the Note IDentifier of the note. Each record must have a unique NID.
  • Form Title - This is a short but descriptive title for the given form.
  • Type/Service - This indicates which clinical service this template is linked to.
    • Note! This code is the old MACSIS-based code, and not the newer HIPAA 837 code.
  • Archive Only? - This indicates if this form as been archived.
    • Note: This functionality was first included in Freemed-YiRC V1.20 and was not available in previous versions.
    • If this is set, new notes can not be created for the given template.
    • Existing notes can be, however, viewed and/or billed for/administrated.
  • View - This allows for a blank template to be viewed.
    • This is useful when importing/creating new forms.
  • Export - This allows you to create an export file for a given template.
    • This export file can then be shared with others for import into other Freemed-YiRC installations.
    • This can also be used to import this design for use with other clinical services on the same Freemed-YiRC installation.
  • Delete - THIS IS DANGEROUS AND SHOULD ONLY BE USED IF THE FORM TEMPLATE WAS CREATED IN ERROR!!!
    • If a given form template is deleted, then all notes created using this template will be deleted as well!!!
    • You should NEVER delete a note template unless you understand the above consequences. There is no simple method to recover deleted templates/individual notes. And if there is no backup of these items, they will be permanently unrecoverable.
[edit]

Importing CCN Form Designs

To import Clinical Casenote Forms, click the Import CCN Form Design link on this menu.

This will then search the usr sub-directory of your Freemed-YiRC installation for any files which match the form of export_ccn_*, where the * (asterisk) indicates a CFS/CCN NID letter. If any files are found, they will be presented in a drop-down selection box.

If you are provided a template form export file from someone, place this in the usr sub-directory of your Freemed-YiRC installation.

The stock distribution of Freemed-YiRC comes with four form templates:

  • NID:C - Individual Counseling
  • NID:D - Diagnostic Assessment
  • NID:P - Medication Somatic
  • NID:R - Group Counseling

After selecting the desired export file, click the Import! button.

The next screen provides several options:

  • Service Type: This is where you link this template form to one of your clinical services (which was discussed earlier in this article and the full list of which can be found in the Clinical Services DB menu).
    • As mentioned previously, a form template can only be linked with one service! If you wish to use the same form template for multiple clinical services, you must import it multiple times, once for each clinical service you wish to link it with.
  • Note ID (NID): This is where you specify the NID. This can be a letter (lower-case) or a number.
    • Each template form must have a unique NID.
    • Please note, however, that even though the Freemed-YiRC Clinical CaseNote (CCN) module uses the same Custom Forms System (CFS) technology as the Incident Report System (IRS) module, you may use the same NID letter/number in both systems (CCN/IRS).
  • Form Title: This is a short but descriptive name for the form template.
    • This will not show up on the form template itself, but is used on Freemed-YiRC menus to identify the form.
  • Billable: This is used to indicate if a particular form template should be billed for.
    • If you select no here, no note created using this NID template will ever be allowed to be billed.
    • However, if you select yes here, you can still specify on individual notes for this NID if they should be billed or not.

Some notes:

  • Just because an export file was created with a given NID letter or number does not mean that you have to import it using the same NID.
    • For example, if you have procured an export file that was created with a NID of c, does not mean that on your installation of Freemed-YiRC you must use it as c. You may opt to use x or 5 for example.
    • Another example: If you've crafted a template and wish to use it multiple times, you can create your own export file, then import it multiple times for other clinical services. Here you can specify different NID letters/numbers.


Upon filling out these fields, click the Next button. The system will then provide a status screen to indicate if there were any issues with the import process.

If there are any errors during the process, it may possibly be due to one of two things:

  • The usr sub-directory of your Freemed-YiRC installation is not writable to by the web-serving software. You may wish to run the FIXPERMS program in the Freemed-YiRC top directory.
  • There may be an already existing file named makedb_ccn_X where X is the NID. This file may be owned by a different user than the web-serving software user (apache or nobody depending upon your operating system, distribution, and version). You can either delete this file or make it writable by the web-serving software.


If the operation was successful, it should state so. When you return to the menu with the list of CCN forms/NIDs, you should now see a record for the newly created NID!

If not, please follow the above directions to fix any errors during this process.


[edit]

Creating Template Form Import Files From Scratch

This is covered in another section of this article.

[edit]

Creating New Templates

To create a new template from scratch using the Freemed-YiRC interface, click the Import CCN Form Design link.

Here you will see several options. These are the same options which are listed when you import a template form:

  • Service Type: This is where you link this template form to one of your clinical services (which was discussed earlier in this article and the full list of which can be found in the Clinical Services DB menu).
    • As mentioned previously, a form template can only be linked with one service! If you wish to use the same form template for multiple clinical services, you must export it, then import it multiple times, once for each clinical service you wish to link it with.
  • Note ID (NID): This is where you specify the NID. This can be a letter (lower-case) or a number.
    • Each template form must have a unique NID.
    • Please note, however, that even though the Freemed-YiRC Clinical CaseNote (CCN) module uses the same Custom Forms System (CFS) technology as the Incident Report System (IRS) module, you may use the same NID letter/number in both systems (CCN/IRS).
  • Form Title: This is a short but descriptive name for the form template.
    • This will not show up on the form template itself, but is used on Freemed-YiRC menus to identify the form.
  • Billable: This is used to indicate if a particular form template should be billed for.
    • If you select no here, no note created using this NID template will ever be allowed to be billed.
    • However, if you select yes here, you can still specify on individual notes for this NID if they should be billed or not.

After filling these out, click Next.

The next screen is the Freemed-YiRC Custom Forms System (CFS) Design Menu. This is where the work will be done to create a clinical form template. This screen is divided into three parts:

  • Form Preview: This portion shows the note as it will appear to the user.
  • Form Preview W/HTML: This portion shows the note with HTML elements displayed for debugging purposes.
  • NEXT FORM ELEMENT: This is where you choose the next form element you wish to add.

The NEXT FORM ELEMENT section contains several main options:

  • Std. Fields - These are the standard fields for clinical notes in Freemed-YiRC.
    • You must make use of all of these fields in any clinical note template in Freemed-YiRC.
  • Cust. Field - This is where you can create nearly any field you wish and have it included on the template form.
  • Drop-Down - Here you can create a drop-down style input selection box.
  • Add An Image - This currently does not work.
  • Text - Here you can add basic text/words to your template.
  • HTML - Here you can add HTML elements to your template.
    • You can either choose from the list of HTML elements, or add your own.

Basically, your task will be to build the template form, one piece at a time. Please keep in mind that you must make use of all of the fields in the Std. Field drop-down!!!

After selecting a single piece to add to your form, you hit the Next button. Upon doing so, the system will give you a preview of the form. If you are happy with the new addition, click the Next button. Otherwise, click the Cancel link.

When you are completely finished with your form, hit the Done link at the bottom of the page. If you attempt to click the Done link before all the Std. Field fields have been used, you will receive an error!!!

Retrieved from "http://www.freemed-yirc.com/freemed-yirc/wiki/index.php/Clinical_Billing_-_Getting_Started"
Personal tools