Billing Charges Tab Data Entry

Charge Lines are organized by Base Rate, Mileage Rate and Other Rates.

Entering the amounts to be billed begins with selecting the code, which populates data from Setup.

Base Rate Line

The Base Rate is what is billed to a payer for the services provided for the patient. This is always the first line of the Charges Tab, and the first Charge Line Printed on forms. Fields are mostly the same for each type of line entered.

Code: These internal codes are provided in the drop-down provided they fall into an effective date range (if entered). When selected, data populates the Description, Cost and Procedure Code Fields on this line.

Description: This field is set up in the Billable Items Area for a specific code. The description can be seen on most printed forms but is not usually provided on electric forms.

Price: This field is also set up in the Billable Items Area for a specific code.

Cost: This is the pricing of the Billable Item, and set in the Billable Items Area for a specific code.

Round Trip: This is the Round Trip Indicator. 

Modifiers: The Mod 1 Slot is populated based on selected locations on the Transport Tab. Additional slots can be added by the Set Conditional Modifier button.

Procedure Code: The Procedure Code is associated with the Billable Item in the Payer Codes Area of the Billing Module Setup. Always review this field when entering charge lines.

If a Procedure Code does not appear, work with the user responsible for the program setup, and review the Payer Codes Area of the Billing Module Setup. The Procedure Codes are payer-specific; a payer must be entered on the bill before these codes can appear.

Diagnosis Pointers: This button is used to make use of the alpha characters designated to each Diagnosis Code, as found in Block 21 and places the value(s) in Box 24E of the HCFA 1500.

Clear: Clears all data.

Mileage Rate Line

Mileage Codes (like the Base Rates) are established in the Billing Module Setup. Select the appropriate code from the Code Drop-Down. Once you enter data into the Miles Field, the program immediately calculates the cost of the entered mileage.

Code: These internal codes are provided in the drop-down provided they fall into an effective date range (if entered). When selected, data populates the Description, Cost and Proc Code Fields on this line.

Description: This field is set up in the Billable Items Area for a specific code. The description can be seen on most printed forms but is not usually provided on electric forms.

Price: This field is also set up in the Billable Items Area for a specific code.

Miles: This field can contain up to four digits. If the mileage goes beyond 9999, then an error will be received. In this even an additional services line must be added.

Cost: The AIM System calculates this field based on the price (established in the Billable Items Setup Area) and the entered miles.  

Modifiers: The Mod 1 Slot is populated based on selected locations on the Transport Tab. Additional slots can be added by the Set Conditional Modifier button.

Procedure Code: The Procedure Code is associated with the Billable Item in the Payer Codes Area of the Billing Module Setup. Always review this field when entering charge lines.

If a Procedure Code does not appear, work with the user responsible for the program setup, and review the Payer Codes Area of the Billing Module Setup. The Procedure Codes are payer-specific; a payer must be entered on the bill before these codes can appear.

Diagnosis Pointers: This button is used to make use of the alpha characters designated to each Diagnosis Code, as found in Block 21 and places the value(s) in Box 24E of the HCFA 1500.

Round Up: Fractional mileage rules apply to most billing scenarios and payers. If a payer requires mileage to the nearest whole number, click this button to round up.

Clear: Clears all data.

Other Rates Line

Code: These internal codes are provided in the drop-down provided they fall into an effective date range (if entered). When selected, data populates the Description, Cost and Proc Code Fields on this line.

Description: This field is set up in the Billable Items Area for a specific code. The description can be seen on most printed forms but is not usually provided on electric forms.

Price: This field is also set up in the Billable Items Area for a specific code.

Cost: This is the pricing of the Billable Item, and set in the Billable Items Area for a specific code.

Quantity: This field acts like the Miles Field, but also indicates how many times a Service Code is billed (instead of entering separate lines for each). Like the Mileage Line, the Qty is used to multiply the price to provide the cost of the line.

Modifiers: The Mod 1 Slot is populated based on selected locations on the Transport Tab. Additional slots can be added by the Set Conditional Modifier button.

Procedure Code: The Procedure Code is associated with the Billable Item in the Payer Codes Area of the Billing Module Setup. Always review this field when entering charge lines.

If a Procedure Code does not appear, work with the user responsible for the program setup, and review the Payer Codes Area of the Billing Module Setup. The Procedure Codes are payer-specific; a payer must be entered on the bill before these codes can appear.

Diagnosis Pointers: This button is used to make use of the alpha characters designated to each Diagnosis Code, as found in Block 21 and places the value(s) in Box 24E of the HCFA 1500.

Balances

These amounts are provided for the original bill (Total Charges), the amounts posted to the      bill (Debits/Credits), and the current balance (Grand Total).

Modifiers

These are codes that represent locations present in the Charges Tab and Charges Lines.

The first alpha character of the Modifier represents the point of origin followed by the alpha character for the destination. Modifiers should be used with every ambulance Procedure Code. Ambulance Transport Codes and Mileage should have an origin/destination modifier.

Complete the full names and addresses of all origins and destinations. If the origin is the scene of an accident without an address, submit the distance for the closest town (for example, “two miles north of Houston”).

The origin and destination for each ambulance transfer must be annotated by the use of a two-character modifier created from the following codes:

D……..Diagnostic or therapeutic site/freestanding facility (ex: radiation therapy center) other than P or H

E........Residential/domiciliary/custodial facility (non-skilled facility)

G.......Hospital-based dialysis facility (hospital or hospital-related)

H........Hospital (i.e., inPatient or outPatient)

I.........Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport

J........Non-hospital-based dialysis facility

N........Skilled Nursing Facility (SNF) (a “swingbed” is considered an SNF)

P........Physician’s office (includes HMO and non-hospital facility)

R........Residence (Patient’s home or any residence)

S........Scene of accident or acute event

X........Intermediate stop at physician’s office en route to the hospital (destination code only)

GM....Multiple Patients on one ambulance trip

QL.....Patient pronounced dead after ambulance called (do not use any other modifiers)

CR.....Catastrophe/Disaster Related (include origin and destination modifiers)

GA.....Waiver of liability (Advance Beneficiary Notice [ABN]) statement on file

GW....Service not related to the hospice Patient’s terminal condition

GY.....Item or service is statutorily excluded or does not meet the definition of any Medicare benefit*

GZ.....Item or service expected to be denied as not reasonable and necessary **

*(Note GY: Use the modifier GY to report ambulance services for patients whose conditions do not meet the requirements for coverage, or for whom ambulance transportation is not covered.)

 **(Note GZ: It is considered inappropriate billing if an ambulance provider uses a modifier that does not describe the origin/destination. For example, if a patient is taken from his residence to the physician’s office in the professional building at the hospital, this transfer should be billed with R for residence and P for physician’s office.)