Charge Entry - Billing for Services

In the final stages of an encounter in athenanet, providers have the ability to signoff services from a third party as potentially billable for claims based on services rendered.  Providers review the Services section to confirm all services entered match those completed in an encounter.  The provider can also edit CPT codes, units, modifiers and diagnosis attached to each service as they feel necessary.  In certain athenanet context setups, procedure codes are automatically populated based on configuration.

Services

The following fields are available under the POST /encounters/{encounterid}/services call

Procedure  Code Valid CPT codes that exist in the context’s Fee Schedule
Modifier Non fee-affecting modifiers to attach to the procedure code. Modifiers can be found through GET /encounter/configuration/modifiers
ICD 10 Code Diagnosis codes added to the encounter in the Assessment and Plan section.  These codes are then tied to procedure codes for the encounter and can be found through GET /chart/encounter/{encounterid}/diagnoses
Units Number of times a service is performed in a given encounter
Bill for Services Denotes whether a procedure performed is billable on a claim

 

Services Workflow

Adding a service to an encounter is handled through POST /encounters/{encounterid}/services.  Each procedure code is stored as a service ID and is shown in the UI on separate line items. Currently only one ICD 10 code may exist for a service through API, but soon we will have the ability to apply multiple diagnosis codes to a service. Note: Please ensure you check for proper modifiers that can be associated with a service by first checking GET /v1/{practiceid}/encounter/configuration/modifiers also confirm allowable procedure codes by checking GET /v1/{practiceid}/encounter/{encounterid}/procedurecodes prior to posting a new service. 

Once a service has been posted, information about services input can be found through GET /encounter/{encounterid}/services which returns a service ID.  This ID can then be used to find specific information through GET /encounter/{encounterid}/services/{serviceid} or to update service.

When updating services through PUT /encounter/{encounterid}/services/{serviceid}, you cannot update the procedure code. Only Bill for Service, ICD10 Codes, Modifiers and Units may be updated for a particular service ID. If a procedure code is no longer a valid service for an encounter, it should be deleted using DELETE /encounter/{encounterid}/services/{serviceid} and a new service added through POST /encounters/{encounterid}/services. 

 

Claim Creation

Services added to an encounter via the API can be created, edited, and deleted until a claim has been created for an encounter.  When a claim is created for an encounter, all of the services added by UI and API are automatically pulled into the charge entry page. Note: services will not appear in the charge entry page for claim creation unless a valid diagnosis code has been provided.  Once a claim has been successfully created for an encounter, you will receive the following error for all calls that are not GETs:

“Changes to services for this encounter are not allowed as a claim has already been created for the encounter."  To determine if a claim has been created for an encounter, GET /claims with parameter appointmentID can be called. 

For more information on this functionality and its use in athenanet, search for the term "Checkout - Claim: Billing Tab" in O-Help in your Preview context. O-Help information is found under the top menu bar - Support - athenaNet O-Help.

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