Conditional Billable Service Types

(Topic Last Updated On: 04/26/2018)

Accounting > Third Party Billing (Advanced) > Conditional Billable Service Types

The Conditional Billable Service Types screen can be found in the Third Party Billing (Advanced) sub-menu, under the Accounting menu. This screen can also be accessed from the Billable Services screen by clicking the ellipsis button next to the 'Service Type' field after choosing the 'Dosing (Conditional)' or 'Unmanaged (Conditional)' Billable Service type. This screen is used to create primary drug/dose type specific Conditional Billable Service types. 'Conditional' meaning the system will charge the set payer/patient rate only when the configured condition is met. Conditions can be configured to charge based on the number of milligrams(mgs) received or number of days dosed in a period. This functionality significantly reduces the number of Payer/Rate Groups that need to be configured by using multiple 'Dosing (Conditional)' Billable Services. This allows users to conditionally charge different rates, and submit claims using different Billable Service data (ie. Procedure Code) as defined for each Billable Service. 'Dosing (Conditional)' Billable Services are also 'linkable', allowing for Linked Billable Services to be charged at the same time a 'Dosing (Conditional)' charge is generated. A basic understanding of Methasoft billing features is helpful when using this screen. Click Here to view Methasoft Accounting and Billing videos.

Field Descriptions

Conditional Service Type Desc

This field contains the user entered description for the Conditional Billable Service Type.

Conditional Service Condition

This field contains a dropdown menu of available dosing and periodic service conditions.

Primary Drug Type/ Dose Type

This field contains a dropdown menu of all available drug/dose type combinations that are setup in the Inventory Dispensing Rules screen, found under the Administration screen. The conditional service will apply to the selected drug/dose type from this menu.

Daily Dosage Min. and Max. mg Thresholds (Optional)

This field appears when a 'Dosing' Conditional Service Condition is selected. This section contains a 'Minimum' and a 'Maximum Value to Charge for Dose' textbox. From these fields, users can configure the minimum and maximum conditional value in mgs that must be met before the Conditional Billable Service is applied.

Total Daily Doses Received Thresholds

This field appears when the 'Periodic - Charge per Total # of Daily Doses per Period' Conditional Service Condition is selected. The textbox fields in this section are 'Min.' and 'Max. Total Daily Doses During Period'. The values entered here specify the required total number of daily doses received in the period before the conditional billable service will be applied.

Show Inactive Types

This checkbox field appears at the top right corner of the screen. When checked, it includes the 'deactivated' conditional billable service types in the grid.

Grid Columns

Conditional Service Type Description

This column displays the user entered Conditional Service type name.

Service Type

This column displays the selected Conditional Service Condition.

Primary Drug Type / Dose Type

This column displays the selected Inventory Dispensing Rule Drug/Dose type combination.

Min Amt

This column displays the user entered minimum amount for any of the 'Dosing' or the 'Periodic - Charge per Total # of Daily Doses' Conditional Service Conditions.

Max Amt

This column displays the user entered maximum amount for any of the 'Dosing' or the 'Periodic - Charge per Total # of Daily Doses' Conditional Service Conditions.

Active

This column shows a checkbox icon indicating that the Conditional Billable Service type is active. Deactivated Conditional Service types display in the grid when then 'Show Inactive Types' checkbox is checked.

Command Buttons

New

This button is used to create new Conditional Billable Service types.

Edit

After selecting a Conditional Billable Service type from the grid, this button allows for changes to be made to its properties. After a Conditional Billable Service is associated with a Billable Service, only the 'Conditional Service Type Desc' field can be edited.

Delete

After selecting a Conditional Billable Service type from the grid, this button permanently deletes the service type record. Service types cannot be deleted after they have been associated with a Billable Service.

Deactivate

After selecting a Conditional Billable Service type from the grid, this button 'deactivates' the service type. Deactivated Conditional Service types display in the grid when the 'Show Inactive Types' checkbox is checked.

Activate

After checking the box to 'Show Inactive Types', and selecting a deactivated record from the grid. The 'Activate' button will appear, replacing the 'Deactivate' button. Clicking this button will reactivate the deactivated service type.

Save

This button applies changes made when creating a new or editing an existing Conditional Billable Service type record.

Cancel

This button will disregard any changes made when creating a new or editing an existing Conditional Billable Service type.

This button closes the Conditional Billable Service Types screen.

Procedures

How to Add a Conditional Billable Service Type
1.) Press the New button. 2.) Enter a description for the service type into the 'Conditional Service Type Desc' field. 3.) Choose a Conditional Service Condition from the dropdown menu. Conditions fall into two categories: 'Dosing' or 'Periodic'. Dosing Conditions - Dosing (Conditional) Dosing - Both - This condition applies the conditional service to both window and takeout doses. Dosing - T/O Only - This condition applies the conditional service to takeout doses only. Dosing - Window Only - This condition applies the conditional service to window doses only. Periodic Conditions - Unmanaged (Conditional) Periodic - Charge per Dosing Visit - This condition applies the conditional service to each window dose within the Unmanaged (Conditional) Billable Service 'Charge Option' period. Multiplying the set payer/patient rate by the number of window visits made within the charge period (ie. Weekly, Monthly). Periodic - Charge per mg - This condition applies the conditional service per mg dispensed within the Billable Services 'Charge Option' period. Multiplying the set payer/patient rate by the number of milligrams(mg) received within the charge period. Periodic - Charge per Total # of Daily Doses per Period - This condition allows for patients to be charged a bundled weekly rate depending on the number of daily doses received during the period being charged. A 'daily dose' can be a window dose, takeout dose, or exception dose. (Split doses are not counted separately.) This functionality allows facilities to charge and bill for different bundled rates which are not based on a fix amount charge for each daily dose. The Min and Max fields are used to define the number of daily doses received during a charge period that will cause an associated Billable Service to charge a patient. The Min and Max values can be different, in which case the number of daily doses received must fall within the defined Min and Max range in order for a patient to be charged. a.) (Optional) Dosing conditions have the ability to set a 'Daily Dosage Min. and Max. mg Threshold'. This feature gives the ability to configure the condition based on how many mgs are dosed daily. This is typically used when creating different Dosing (Conditional) Billable Services where the rate varies depending on the number of mgs the patient receives. (ie. If the rate is different for patients receiving over 200mgs, a dosing condition can be set to a minimum value of 0 and maximum value of 200. Another dosing condition can be set to charge a different rate and set the minimum value of 201 and a maximum value of 1000.) 4.) Select the Primary Drug Type / Dose Type Inventory Dispensing Rule from the dropdown. The Conditional Service will apply to dosing instances using this drug/dose type combination. 5.) Click Save.

How to Add a Conditional Billable Service Type from the Billable Services Screen
1.) From the Accounting menu, click on the Billable Services option. This will open the Billable Services screen. 2.) Click on New. 3.) From the 'Billable Service' dropdown menu, choose 'Dosing (Conditional)' or 'Unmanaged (Conditional)'. 4.) To the right of the 'Service Type' field, click on the ellipsis button. The 'Conditional Billable Service Types' application window will appear. 5.) From the application window, create the new Conditional Billable Service type following the steps in the procedure above. 6.) Click on Save to create the new Conditional Billable Service type. 7.) Click on Close to close the application window and to be returned to the Billable Services screen. 8.) Enter a 'Service Name' for the Conditional Billable Service. 9.) Make all other required Billable Service property selections including the payer and patient rates. 10.) Click Save.

How to Edit a Conditional Billable Service Type
1.) Select the Conditional Billable Service type record to be edited from the grid. 2.) Click the Edit button. 3.) Make the desired changes to the properties of the record. Conditional Billable Services that are already associated with a Billable Service, can only have their 'Conditional Service Type Desc' changed. Otherwise, a 'Netalytics System Message' will pop-up indicating that the Conditional Billable Service is associated with a Billable Service and that the properties cannot be edited. 4.) Click Save.

How to Delete a Conditional Billable Service Type
1.) Select the Conditional Billable Service type record to be deleted from the grid. 2.) Click on the Delete button. 3.) A 'Delete?' confirmation dialog box will appear. If you are sure you want to permanently delete the service type, then click Yes. If the service type is already associated with a Billable Service, a 'Netalytics System Message' will pop-up indicating that the Conditional Billable Service is associated with a Billable Service and cannot be deleted. 4.) Click OK to close this dialog box.

How to Deactivate/Activate a Conditional Billable Service Type
To Deactivate a Conditional Billable Service Type 1.) Select the Conditional Service type record to be deactivated from the grid. 2.) Click on the Deactivate button. 3.) A 'Deactivate?' dialog box will appear confirming the deactivation. 4.) Click Yes to deactivate the service type. To Activate a Conditional Billable Service Type 1.) Click on the box at the top right of the screen to 'Show Inactive Types'. 2.) Select the inactive service type record from the grid. 3.) Click on the Activate button.

Considerations

Deactivated Conditional Billable Service Types Still Appear on the Billable Services Screen

Conditional Billable Service types, that are associated with a Billable Service, cannot be deleted. They can only be deactivated from this screen. After the service type has been deactivated, it will still appear as a Conditional Service on the Billable Service screen. Billable Services with applied charges/claims cannot be deleted. *See the Billable Service topic for more details.

'Periodic Charges' Nightly Process for Unmanaged (Conditional) Billable Service Types

Unmanaged (Conditional) services are charged automatically by Nightly Processes. Based on each services 'Charge Option' configuration, the Nightly Processes will apply the configured charges. Charges can be deleted and/or generated for these services using the Charge Manager screen found in the Accounting menu.