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Inhibit Billing By Service - PM

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About Inhibit Billing 

To inhibit billing means to not included it on an outbound claim so that it remains an un-billed service. There are many reasons you might want to inhibit a claim:

  • If it is a possible duplicate
  • If it needs further review
  • If a client has duplicate client IDs that need to be merged
  • If a provider is pending Medicare enrollment
  • If a provider’s credentials have expired
  • If the client has eligibility issues
  • If there is an incorrect Client Index Number on a record
  • If the client’s authorization has expired

When you inhibit a claim, you can add remarks or reasons to those records. This creates an easy way to monitor and track inhibited services, so you can follow-up appropriately.

To Inhibit Billing by Service 

  1. Navigate to: Avatar PM > Billing > Bill Production > Inhibit Billing By Service
  2. In the Rendering Practitioner field, enter the practitioner name, and select.
  3. In the Client ID field, enter the client name, and select.
  4. In the Episode Number field, select the client episode.
  5. In the Program Where Service Was Rendered field, select the treatment program.
  6. In the Search Start Date field, enter the date.
  7. In the Search End Date field, enter the date.
  8. In the Liable Guarantor field, enter guarantor name, and select.
  9. In the Select Service(s) To Mark Billing-Inhibited field, select the services.
  10. Click Submit.

NOTE: Non-billable services do not display on myAvatar PM bills.

Configuration

Inhibit Reasons

Once the update is installed applicable, organizations will need to configure the ‘Inhibit Reasons’ they want displayed on the ‘Inhibit Billing by Service’ form. These will need to be added using Dictionary Update for the following dictionary:

Other Tabled Files - 20515 Inhibit Reason

Solution Enhancements

Inhibit Billing by Service

The ‘Inhibit Billing By Service’ form was updated to add the ‘Inhibit Reason’ and ‘Inhibit Notes’ fields.

 

Field Name Description
Inhibit Reason Allows users to select a from a user-defined list of inhibit reasons.
  • The field defaults to blank and disabled.
  • The field becomes enabled when a service is selected to be inhibited.
  • The values displayed in the drop-down list should be user-defined.
  • The Inhibit Reason is not be required.
  • Only one item can be selected from the list.
Inhibit Notes Allows the user to enter notes for the service being inhibited.
  • The field defaults to blank and disabled.
  • The field becomes enabled when a service is selected to be inhibited.
  • The Inhibit Notes is not required.

When the form is displayed for a client that has inhibited records, the inhibit reason and any notes are displayed.

 

Client Inhibited Services (Service Date Less Than 1 Year Old)

The following widget has been added to show a list of all clients that have at least one service with a date of service less than one year old that has been inhibited. This provides a quick an easy way to track clients that have an inhibited services. 

 

Services Inhibited for Billing

This report will provide billing staff with a list of all services that have been inhibited for billing. When running this report, the user can select to run the report for a specific ‘Inhibit Reason’ or Client, as well as a date range. 

The report will show both the inhibit reason and the remarks as shown in the example below.

 

Registry Setting

  • Enable Inactive Program Selection