Setting Up Your Funders and Billing Codes.

Go to Settings

Select Funder Settings from the menu at the top

Click Add Funder to add a new funder to your account. Click View for an existing Funder, then click EDIT to set up the Billing and Scheduling Rules for that Funder

Once you click EDIT or ADD FUNDER, choose the Funder Type from the drop down

• Insurance: Group Health Plans, Commercial Payers, Medicaid, Tricare

• Other: Schools, Regional Centers, etc.

• Private Pay: Self Pay

  • Please note for Private Pay, you may have to enter some fake information to fulfill the requirements. You will also choose your scheduling rules based on what you want to allow

OPTIONAL: Add a Vendor ID (if applicable)

• Used for California customers to appear on the Parent Verification Form and BHPN Invoices

Type out the Funder Name

• If you are setting up a Private Pay funder, you can name it “Private Pay”

Enter Funder Address

• Phone, Email, and Fax are optional

• For Private Pay: Enter in a placeholder address

Set the Billing Rules: These will be based on your funder contracts

• Select the checkbox if you want to convert session times to military times on your billing export

• Select the check box if you want to require the referring provider be entered on client authorizations and show up in your billing export

• Select the check box if you want the appointment time on the claim line in your billing export

  • The verified appointment time will be listed on the billing export regardless. If your Funders request it to be specifically in the claim line, select this

Select your Combine Rules based on your funder contracts

• These are not the combining of appointments. This is on the backend for billing purposes and will dictate how appointments are seen on the Billing Export Report pulled from the Reporting Dashboard

• Oftentimes Self/Private Pay will choose “Don’t combine charges”

• Some Funders want you to combine charges for the Same Day, Client, and Procedure & others want you to combine charges only if it is for the same Day, Client, Procedure, AND Rendering Provider

Set Scheduling Rules: this allows you to decide if concurrent billing should occur or what type of warnings you will or will not receive when scheduling appointments

• Select Don’t Allow, Allow, or Warn & Allow to the first few Scheduling Rules based on your Funder Contracts

  • Warn & Allow will give you a soft warning when trying to schedule but will still allow you to save that appointment

• Select the Checkbox if you want staff to be able to verify appointments on expired certification

• Option to restrict users from scheduling on specific dates

Option to add Medicaid ID #

• This area would allow you to choose the applicable Medicaid ID # from the drop down to attach to the funder

• The drop down will be a list of the Medicaid ID#'s that are entered in the Settings>Company>Basic Information

• This information does not pull through into the Billing Export Report

Option to add Insurance Plans

• This area would allow you to keep track of the different plans within that funder such as if the funder had a Platinum or Silver plan option

• When you set up your clients you can then assign which insurance plan they have according to that funder

• If you have signed up for the Rethink Self-Billing product, your Self-Billing Implementation Specialist will train you on this area

Select the Coverage Type (only applicable for insurance type funders)

• Most commercial plans will be classified under “group health plan”

Select Service Facility (only applicable for insurance type funders)

• If you have more than one location available you would want to choose your main office location/the location your funders have on file for billing purposes

• Please note that the service location is pulled from the location assigned to the client in Rethink, this area is just for documentation purposes

Select whether to Omit Session Note Header fields

Allows users to exclude the client-assigned facility/location, service, or service line from the header details on billable or non-billable session notes (with a selected service) saved to the client file cabinet.

• When changing selections, existing session notes will not be impacted. The changes will take effect for new session notes

• Users will need to edit existing session notes if they desire the updated selections to be reflected on the saved session note in the client file cabinet

• This feature does not apply to non-billable appointments with no service selected.

Click View on your applicable funder, and then scroll down to add a Service Line

• Billing-Claim/Invoice Submission Method is not currently an active feature

  • Recommended to leave it as it is already selected

Click “+” to add Billing Codes to the Funder Profile:

Add Service and Billing Code details (any fields marked with an " * " are required)

• If you have funders authorizing units by specific modifiers for the same billing code you can do the following: Create Service names in your Settings that include the modifier or add language to the service name that matches the authorization. Then when adding the billing code to your funder set up, make sure you select the restrict by credential option so you can add the modifier(s) for the matching staff credential.

Does NOT require Authorization

• This field is not recommended to be selected unless you are an international customer or building a Private Pay Funder and do not wish to track authorizations for scheduling/utilization purposes

• Selecting this option will break the authorization functionality and you would no longer be able to utilize authorizations for billing or tracking purposes

• You can mark on the individual client authorization page if an authorization is not required but marking it here would break that functionality for all clients with that funder

Restricting staff from providing a service or to bill multiple rates for a service

• To restrict which staff can provide a service and/or to be able to bill multiple different rates for this service click "yes" then complete the required fields. This will prevent any staff who do not hold the appropriate professional credential from being scheduled with that service

• If you select “no” any staff could be scheduled with that service

• You will want to select “yes” if you need to add in modifiers or telehealth services as well

Select a Service and Choose a Template to pair your services with the applicable billing code

• If your billing code is not present in this templated list, select “custom” and manually type the code into the billing code for claims/invoices section

Unit Type: Select the unit type that is appropriate for your billing code

• If you have selected one of the templated 9 codes, the unit type will default to 15 minutes

Rounding Rule: Insurance providers do not allow partial unit billing so you must choose a rounding rule

• Please see the Rounding Rules chart below

Contract vs. Billing Rate

• This feature holds no functionality as of right now so it is recommended to leave it set as contract rate

• The rate you enter is whatever you want to see on your Billing Export whether that be your Funder Contract Rates or your Company’s Rates

Add Credentials and Rates

• Click “Add New +” to add all the professional credentials who can provide this service

• Option to add modifiers

• Option to add Telehealth Services by selecting the same credential more than once, entering in the modifier and the Service Description of “Telehealth” (See example below)

No Rounding

System Default: System will round unit to

next 2 decimal place, not whole units

Round to Nearest

15 min unit (less than 8 min = 0 greater than 8 min =1 )

30 min Unit (less than 16 min = 0 greater than 16 min = 1)

60 min Unit (less than
31 min = 0, greater than 31 min = 1)

Round Up

IF length of appointment breaks the threshold

by at least 1 min into the next unit, the system will round up.

Round Down

Any partial units are thrown out

15 min unit (less than 15 min = 0 greater than or =15 min =1 )

30 min Unit (less than 19 min = 0 greater than or = 30 min = 1)

60 min Unit (less than 59 min = 0, greater than or = 60 min = 1)