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Billing Profiles Setup will require the Role Permission "Billing Profiles" to be enabled in Roles Setup. By default, only Administrators can access Billing Profiles Setup. However, once configured, any user can select a profile on a bill.
Table of Contents
Profiles Setup Overview
Before using Billing Profiles, it is helpful to have a base-level understanding of Field Configuration Setup. Billing Profiles are meant to automate the majority of the data entry for repetitive transport types to allow billers to quickly bill certain routine transports. This is achieved through defaulting answers to data entry questions, much like what can be done in Field Configuration Setup. An understanding of Field Configuration Setup's settings and functions really helps outline the necessity of Billing Profiles when it comes to automation.
To create a new profile, visit Billing Setup > Billing Profiles Setup:
Billing Profiles Setup contains all profiles created by the agency. New profiles can be created, updated, and even duplicated for quick creation of new profiles within this screen. As noted above, access to this setup screen requires the Billing Profiles role setup permission.
- Profile Name column shows the user-defined name for that profile.
- Payer(s) column shows the payers this profile applies to.
- Action column shows the following buttons:
- Duplicate: Copies this profile to allow users to quickly make updates while drastically reducing the effort required for new profile creation. Duplicate a profile to make a few changes for a different payer or transport type - this is much more efficient than creating a new profile from scratch if the new profile has similar data entry.
- Edit: Allows users to edit this profile to make changes.
- Delete: Deletes the profile, making it unable to be used on new bills moving forward. Deleting a profile will remove that profile from selection for all users.
Profile Creation
To create a new profile, use the Add button in the top-right corner.
In this example, we are creating a basic Wheelchair Van profile to automate the routine data entry of these sorts of transports. Next, enter a Profile Name to provide a distinct name for this profile. Afterwards, users can select the payer(s) that this type of profile applies to.
To make things efficient, select only the payer type(s) or specific commercial payers that this profile can apply to. This will limit the profiles applicable for selection when using this Profile on a bill. Users can alternatively select "All" in order to be able to use a profile for any payer instead. Use discretion when adding profiles for all payers in order to mitigate data entry mistakes and keep the profiles available to a minimum when choosing to apply a profile to a bill.
The next step of creating a new profile is to select the default values for the data entry screens.
Much like Field Configuration Setup, users can configure default values for certain data entry screens of a bill. Usually Field Configuration Setup allows for default value functionality but for certain repetitive transport types some data entry might not be able to be defaulted for each bill of that payer type. Profiles Setup allows for a different approach to automating data entry by allowing the system to overwrite these settings just for that specific kind of transport profile.
Billing Profiles, when applied to a bill, will overwrite data from Field Configuration Setup or data that carried from last trip.
Billing Profiles will not overwrite data that was manually-entered or modified before the Profile was applied.
Billing Profiles have the capability to automate much more than Field Configuration Setup, allowing for certain areas such as the Transport, Diagnosis, and Charges Tabs to be automated.
This example shows the Charges defaulted for a certain transport type.
This next example shows some ICD-10 codes defaulted for the diagnosis tab. Up to 5 ICD 10 codes can be defaulted per profile - only the code itself needs to be entered (the corresponding description will appear automatically when the profile is applied). This is not necessary for all profiles, but exceedingly helpful in cases where the ICD 10 codes will always remain the same. Billers with a lot of experience will note that variance in the diagnosis codes submitted for patients oftentimes lead to better rates of acceptance from insurance payers, unless billing a repetitive transport type like Wheelchair or Dialysis.
Even the Bill Narrative Tab can be automated through selection of a Narrative Template.
The most automation occurs in the data entry screens of the various payers that can be added to bills using the Bill Payer ANSI 5010, Commercial, HCFA 1500, Patient and Bill Payers pages.
- Fields can be defaulted much like Field Configuration Setup in these pages, allowing the answers selected in Profiles Setup to populate once a profile is selected.
- Date fields have a configurable option to populate the date of service of that bill when the profile is applied. Keep in mind that while this is available for every date field in these setup screens, the date of service is not always the applicable date, so please use discretion when enabling this option.
Even the Transport Locations can be defaulted for certain profiles:
Applying Profiles
Before selecting a profile, keep the following in mind...
- Please add the PRIMARY payer to the bill prior to applying a profile.
- Selecting the profile on the primary payer will populate data in the Charges, Diagnoses, Narrative and Transport tabs.
- If a payer is added to a bill after the profile is applied to the primary payer, a profile can still be applied to that payer but it will not:
- Populate any data outside of the data entry for that payer.
- Overwrite any data that had populated from a previous profile selection.
To apply a profile, click the Edit button on the Payers tab for a bill's primary payer. Use the Profile dropdown in order to select a profile:
Adding a new profile to a bill will cause all of the predetermined data to populate in all of the data entry fields entered for that profile under the Page corresponding with that payer's form type in Profiles Setup.
If multiple payers exist on the bill, applying a profile to the bill will cause data to populate for all of those payers. For example, if the primary payer on a bill is a medicaid electronic policy, and the secondary payer is a patient invoice, if the profile being applied to the bill has default values in both the Bill Payer ANSI5010 and Bill Payer Patient pages, default values will populate for both payers once the profile is selected.
Users can re-select profiles if needed in order to switch the data that populated with the original profile with data from another profile if the wrong selection was made previously.
Keep in mind that if a profile is applied to a bill, and subsequently it is determined the profile should be removed, users must either disable edit to lose their changes or manually remove the data entry. It is recommended to not save the bill until the user is sure that all information that populated is applicable and correct so that the data can easily be removed by disabling edit mode if a profile is determined to not be needed after it is applied to a bill.