Service Line Consolidation
Overview
In 837s, many times each service can be claimed separately. However, some services need to be grouped together on a single claim. Complete the steps in this article to set up services and rates when you need to submit multiple services on the same claim.
Set up Consolidation Categories
First you'll need to set up consolidation categories in the finance setup tables. Each category you setup will need to consolidation by a period. The period list comes from the standard periods available in myEvolv. In almost all cases you'd use either Day, Week, or Month, however, you are not limited to just those three.
Menu path
Finance Setup > General Setup > Setup Tables > Claim Consolidation Category
- Navigate to the following path: Finance Setup > General Setup > Setup Tables > Claim Consolidation Category.
- In the toolbar, click New
> Claim Consolidate Category. - In the Claim Consolidation Category dialog, enter a Description, Shortcut Code, and select a Consolidation Period.
- Click Save.
Link Consolidation Categories to a Rate Headers
Consolidation categories are linked to rate headers (Rate Setup tab on rate setup areas below).
Menu Path
Finance Setup > Billing Rates (A/R)
- Navigate to the path: Finance Setup > Billing Rates (A/R).
- Select any of the Rates Setup options below.
- In any of the rates setup areas, in the toolbar, click Select a Rate
.
Note: In the Select a Rate dialog, you can search for and select a rate by the Consolidation Category.
- In the Rates Setup details, in the Service Line Consolidation Category field, select a consolidation category.
- Click Save.
Link Consolidation Categories from Payer Information
You can also quickly link consolidation categories to rate headers from the payer information screen.
Menu Path
Finance Setup > Payer/Contract Setup > Payers > Payer Information
- Navigate to the following path: Finance Setup > Payer/Contract Setup > Payers > Payer Information.
- In the toolbar, click Select Payer
. Search for and select a payer. - In the Billing Rates defined tab, in the Claim Consolidation Category column, click the ellipsis
and select a claim consolidation category.
- Click Save.
Link Rates to the Billing Scheme
After you setup the categories and then link the categories to the rate headers, you must link the rates to billable program and services on each applicable payers' billing contract. If you are simply updating your existing rates that are already linked, you would skip this step.
Billing Results:
Service Line Structure
On the billing report, service lines display.
To view the claim directly, click on claim number.
You can also view the actual records on the submission record.
Example Setups
Below are common business examples. Use the examples to apply to other services or lines of business.
All Services in a Day
Sometimes a funder wants all services provided in a day to be sent on one claim with multiple service lines. For example in New York, all services for a day that bill under the same Rate Code (NY Only) need to be billed on one claim with multiple service lines.
Here is an example contract setup with rates.
All rates on this contract are tied to the same Service Line Consolidation category.
Here are services provided in a program where all services are consolidated for a day.
Here are the results.
Interactive Complexity
Interactive Complexity must be claimed with the service where it was provided. Standalone claims for interactive complexity are typically denied. Interactive Complexity can usually be provided with individual therapy, group therapies, and assessments.
If you typically do not provide these three services in a day, you can create one rate for the interactive complexity and use the same consolidation category on all four rates. However, if you can provide and bill for more than one of these three services in a single day and can only claim the interactive complexity with the service it was actually provided with, you must create separate rates and separate consolidation categories independently for each service.
Below are what rate setups look like associated to services on a contract.
In this example, we assume you cannot bill any of these three in the same day and your front desk will not schedule any on the same day.
All Rate Headers have the same Consolidation Category set up and linked.
The interactive complexity rate history has provision to only bill if Interactive Complexity is checked on the service event.
On the event entries where this was provided, the following must be checked.
If this field is currently not visible on your service forms, you will need to add it in form designer.
This is an event_log field.
Services are entered.
The two highlighted above have been marked with Interactive Complexity.
Billing run results.
Interactive Complexity is billed as a service line to both 2/1 and 2/2 service.
E/M + Therapy
If a doctor provided therapy with an E/M service, you’ll most likely need to put the services together on the same claim.
The best way to setup clinically is to have the therapy session setup as an “Other Activity” that will be entered with the E/M service. Setup a specific Claim Consolidation Category for just E/M and Therapy.
Note: For NY clinic billing, use the same consolidation category you’re using for all codes billed in a day for the same Rate Code.
Other Activity event.
Separate rates linked to both services, but both rate headers use the same Claim Consolidation Category.
Entering the service.
Note: You should NOT allow the Physicians Therapy event to be entered individually (Service Entry). These therapy codes should only be billed with E/M.
The therapy is entered as an Additional Service. Notice, you can put Interactive Complexity here too.
Here is the E/M data collected and used for billing.
Billing Results:
Crisis Psychotherapy
For Crisis Psychotherapy, you can bill two procedures together depending on the duration of the session. To assure the services get claimed together, use service line consolidation.
Rate histories need to be like the following:
90839
The general premise is you bill 90839 provided the service entry has a minimum amount of time. The minimum time will vary based on the funder’s requirements. It could be as little as 15 minutes or as high as 60 minutes to bill. Use the time chart that bills one unit for the service.
90840
For the additional time where you bill one unit per additional 30 minutes, setup rate to drive this by the time chart. The above example assumes you can start counting the additional unit once you’ve met the one-hour threshold. Below, we start counting at one hour and increase the units for every 30 minutes.
Using the Time Chart tester in the time chart setup you’ll see the following:
Here, we have one unit once the duration hits at least one hour. If you do not want the unit calculation to start until one and a half hours (1:30), use this number as the “Start Counting (hh:mm)” value.
Here we don’t count units until 1:30.
At 2.5 hours.
ABA Services
This works pretty much the same way as crisis. Like crisis, each ABA service where you need to bill multiple service lines based on duration should have its own Claim Consolidation Category. Simple example:
Example with setups
Client has three hour services.
Note that only 1 entry/note is per day.
Setup Data.
Have two rates set up and linked to the service. Assume the event below is the behavioral follow-up.
Each rate has same service line consolidation. This is what makes multi service lines in myEvolv.
Initial 30 minutes setup.
As long as the service is one minute, bill this code with this amount as one unit.
Code each additional 30 minute setup.
Bill this code for this amount for every 30 minutes start counting at one hour.
Logic for units and start counting at one hour is in time chart setup.
This will kick in 1 unit for the second CPT once one hour of service is provided. At 1:00, you get 1 unit. This time chart could be setup to start counting at a different number. For example, if at the 31st minute of service you can bill that extra unit, enter in Start Counting as 00:30. This will kick in 2 units at 1:00 and increase units each 30.
Other Miscellaneous Information
Service Line Consolidation can be used on Residential and Attendance based rates.
Residential Example: In some states and programs you may need to bill separately for Treatment versus Room and Board. However, your funder wants the billing on one claim with separate service lines for each component.
Attendance Example: You may bill weekly for attendance and use the check in and check out feature of myEvolv. You can bill for the entire week if the client attends three days out of the week. On the rate history of the attendance rates, consolidate the services for a day. On the rate header, use a service line consolidation category that will group by Week. In this example you setup all in one rate.
Other Fields on Rate Header Affecting Service Line Consolidation. The following fields below the Service Line Consolidation Category field only become active when selecting a service line category.
Max Units – The system will cap the number of units produced on the claim by the number entered here.
Use Consolidation Category Period for Claim Dates – When billing is ran, the system uses the period date instead of the actual dates of service billed. Example: you use Service Line Consolidation for a week. The last billable day that is produced is Thursday. However, your funder wants on their claim/statement the full week dates (Sunday – Saturday is default in myEvolv for Week). There are two exceptions to this rule when checked: 1. If the client’s enrollment date is within the period, use that date instead of the first date of the period. 2. If the client’s discharge date is within the period, use that date for the end date of the claim instead of the last date of the period.
Use Claim Dates when Outputting Claims – By default on 837, CMS1500 and UB outputs, the system outputs the dates on the service lines. Checking this box tells the output program to use the date on the claim for claim dates instead of service lines. Check this when you have a multiple service line claim but need to output the statement date on the claim level.
Consolidate for Consecutive Dates Only – Does the same thing as the field of the same name on the rate history except it applies to claims with multiple service lines. When checked, if there are dates within the consolidation period that are not billable, the system will break the claims by those dates.
Group Service Lines together on Output – Use this when you want to output a single service line in output if the claim has multiple service lines. Requires each service line to bill with the same CPT code. This setting is typically used in non-insurance billing when you need to use service line consolidation to get claims to produce properly but need to output only a single line for paper output.