In this article, we will break down the Billing section found within the General Information tab. You can follow the article or jump to the section needed below.
For information on other sections within the General Information Module, you can simply click on the section you wish to explore: [General Information: Case] [General Information: General] [General Information: Schedule] [General Information: Users/Therapists] [General Information: Validations]
General Information Module: Billing
Jump to Section [Adjustment Reasons] [Claim Based Reporting Tests] [Charge Codes] [Charge Sets] [EDI Identification] [Statement Messages (Clinic)]
Adjustment Reasons
Adjustment Reasons are used when posting transactions to a patient’s account.
A right-click opens the menu shown below.
Adjustment Reasons
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Add |
Adds a new adjustment reason. |
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Delete |
Removes an adjustment reason. |
NOTE: Deleting an adjustment reason does not remove it from the transactions to which it is currently assigned. Deleting it prevents it from being used in future transactions.
Charge Codes
The Charge Codes section contains the overall fee schedule for Fusion Enterprise.
Charge Code Grid
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Category |
The group a particular code belongs to. |
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CPT |
The code and any modifier. |
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Name |
The name of the code as it will be seen in the drop-down menu on the Therapist Charge Entry module. |
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Description |
A long description of the charge. Useful for entering key information about a charge to help the therapist when entering charges. For example the number of minutes per unit. |
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Level |
Charge level 1 or 2. Level 2 billing is seldom used in Physical Therapy. Level 2 charges will be printed on a separate claim from Level 1 charges. |
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Charge |
The dollar amount of a single unit. |
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Ins Billable |
Indicates the charge should be billed to the insurance company. Charges not marked as Insurance Billable will not be printed on the claim; however, they will still show on the patient statement. |
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Classification |
Can be set to DME, Evaluation, Modality, Procedure or Unclassified. This is useful when composing Charge Validation rules. |
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Line Note |
Indicates whether or not the Name will be included on the claim form. |
A right-click opens the menu shown below.
Charge Category Menu
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Add |
Adds a new code. |
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Edit |
Edits the currently selected code. |
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Delete |
Deletes the currently selected code. This will not affect current charges that use this code. |
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Alternate Fee Schedules… |
Allows you to access alternate fee schedules. This allows you to set up multiple prices for each charge code. These fee schedules can then be assigned to individual cases. NOTE: This feature may not be enabled in your installation. Please contact Fusion Enterprise if you require this feature. |
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Mark as No Show Charge |
Allows you to assign the selected charge to be used on the schedule as the No-Show Charge. |
When adding a charge code, you will be prompted with an entry box to add the code as shown.
NOTE: In Fusion Enterprise the same code may not be in the system twice. Each charge code and modifier combination must be unique.
In therapy, there are several different modifiers, those that affect the price and those that do not. Modifiers that affect price have to be entered with the code.
For example, the CPT code for supplies is 99070. 99070-01 might indicate a Lumbar Roll for
$35.00, whereas a 99070-02 might be a Cervical Roll for $25.00. Having the modifier in the code allows you to set a price for each of these.
TIP! For codes that do not affect price, it is up to your discretion to include them with the code. We suggest you use these where they are unique and do not enter charge code modifier combinations that affect all codes.
NOTE: In regards to the GP and GO Medicare modifiers, Fusion Enterprise handles these modifiers automatically.
Alternate Fee Schedules may be accessed by selecting Alternate Fee Schedules from the menu.
To add a new fee schedule, right-click in the grid area and select Add New Schedule from the menu. You will then be prompted for a name for the fee schedule. This is the name it is going to be referred to in the case, so you will want it to be short and concise as to what the fee schedule pertains. After a new schedule is created, all charge codes from the main fee schedule will be copied over to the new schedule. It is then possible to edit any of the prices in the new schedule.
IMPORTANT: The main fee schedule and all alt fee schedules will have identical codes. If a code is added to the main fee schedule, that code and price will flow through to all other schedules. When adding a new charge code, be sure to adjust the price on all fee schedules accordingly.
Charge Sets
Charge sets are created in the Charges and Documentation module and are known as favorites. These favorites may be deleted here, or they may be made public so they will show up on everyone’s favorites list.
EDI Identification
This section allows you to enter additional EDI information, which may be required for the ANSI 837 claim format.
Right-clicking presents the following menu:
Add creates a new EDI entry, Edit allows you the alter the currently-selected row, and Delete removes the currently-selected row. Your clearing house or carrier will direct you as to the information they need you to provide here. This information will appear in the header portion of your 837.
Statement Messages (Clinic)
Most statement messages are used in the patient statement forms, but one, Receipt_Thank You, is used on the patient receipt. FUSION ENTERPRISE has nine messages built in, but you are not required to use them all.
The message text for each message can be edited by choosing the Name from the dropdown menu, right-clicking, and choosing Edit Message. The patient statement forms included with Clinic Controller utilize the Remit, Contact, and any Dunning messages. The patient receipt utilizes the Receipt_Thank You message.
Right-clicking the list provides you with the following menu:
Edit Message allows you to change the text of the message.
The import and export features are available to import a text file into the body of the message or export the body of a message to a text file.