UB-04 Billing: AdvancedMD Setup

UB-04 Billing: WebPT Setup

If you want to use UB-04 billing with your AdvancedMD integration, you will need to contact WebPT Support to turn on the feature for you. Next, create or adjust insurance settings for each payer requiring UB-04.

You will also want to contact AdvancedMD support to confirm UB-04 enabled, and verify setup for interface compatibility.

Insurance Settings

UB-04 Billing is applied at the insurance level and will need to be turned on for each insurance that uses UB-04 billing. You must be an Insurance Admin to complete these steps. Because the UB-04 Setting is selected on the insurance level, patients having multiple cases with the same UB-04 insurance will have all charges related to these cases mapped to a single episode in AdvancedMD.

Navigate to the Insurance Manager.

  1. To edit an existing insurance, select Display Insurance, locate the insurance, and then click Edit to the right.
  2. To add a new insurance, click Add Insurance in the Insurance Manager.
  3. Under the Settings column, check the box to Apply UB-04 Billing. 
  4. Click the Settings link and change the Monthly Billing radio button to Yes. You can also set your defaults for Admission Type and Source, which will prepopulate in the patient’s case when the insurance is selected. All other settings will be input either in the case or directly in AdvancedMD. 

This will flow into the  Episode in AdvancedMD.

Episode

  1. To access the episode in AdvancedMD within the patient record:
    1. Patient Demographics > Transaction Entry > Episode, or
      1. Patient History > Select visit > Edit visit > Manage Episodes
  2. Click OK on the settings window and then click Edit/Add Insurance to save the insurance settings.
  3. To verify the Carrier monthly billing setup in AdvancedMD, go to Master Files > Carriers > Select Carrier > EDI/Other > Enable Monthly Billing checkbox.

UB-04 Billing: Integration

Let’s review how UB-04 billing is completed. We will start by creating a patient case and then show UB-04-specific fields in the SOAP note. For each UB-04 field, we will also show where this information appears in AdvancedMD.

Creating the Patient Case

  1. Navigate to the patient chart. Click Patient Info.
  2. If you are using a new insurance, locate and add it to the Insurance tab.
  3. Next, add a new case.
  4. Once you add the UB-04 insurance, drop-downs for Admission Type and Admission Source become available. These will pre-populate based on your selections in the UB-04 Settings when adding the insurance, but you can update them as needed.
    1. This will flow into the UB Information - Visit in AdvancedMD.
    2. To access UB Information within AdvancedMD: Patient History > select a visit > Extra Info > UBXX.
  5. Next, select the Related Cause.              
    1. Based on the cause selected, the corresponding accident will populate in the Extra Information section of AdvancedMD. Please note that AdvancedMD will need to know the type of accident coverage to select the appropriate occurrence code (01,02,04,05). The Date of Injury is pulled from the Injury/Onset Date/Change of Status Date field in the evaluation.
    2. To access the extra information screen within AdvancedMD: Patient History > Select a patient > Edit Visit or Charge Detail > Extra Info Button OR Episode > Extra Info button.
  6. Input the Number of visits the patient has already completed prior to this case, if needed. **Only used during the onboarding process. 
  7. This will appear in the Episode in AdvancedMD. The user type of the therapist assigned to the case in WebPT will determine the section the visit count is assigned to. 

Additional Cases

If the patient has multiple cases in WebPT with the  same UB-04 insurance attached to both cases you will see only the first case listed in AdvancedMD as an episode.

WebPT

AdvancedMD

Initial Exam: Integrated Fields

  1. Input the Date of the Initial Examination
  2. This flows into the Episode in AdvancedMD as the Plan Create Date.  (This is the date that the Comprehensive Outpatient Rehabilitation Plan was established or last reviewed. Upon claims generation in AMD, this will produce Occurrence Code 28 on the claim if all other CORF components are present.)  See AdvancedMD Occurrence Code Generation Rules below.
  3. To access the Plan Create Date, refer to the above instructions.

AdvancedMD Occurrence Code Generation Rules

Additionally, the Evaluation Type and Date are generated based on the Evaluation Specific CPT codes that are billed in WebPT. The Evaluation type pulls from the CPT codes that are billed. For example, if the PT bills 97161 on April 18, 2018, the date and type will be reflected in the same way (see below). This will work the same way for OT codes such as 97165 – 97168. It will also work this way for Speech Therapists with codes such as 92521.

Upon claims generation in AMD, the following occurrence codes are produced on the claim if all other CORF components are present:

  • 35Physical Therapy - Oldest evaluation date & therapy type is PHYSICAL. Date that treatment was started for therapy. This date is pulled from the earliest physical therapy evaluation date in the Evaluations screen and the date always remains the same for all visits tied to the episode.
  • 29Physical Therapy - Most recent PHYSICAL evaluation date based on DOS not already used AND Occurrence code 35 present (either manually or automatically from this list) Date the outpatient therapy plan was established or last reviewed. This is the closest evaluation or reevaluation date on or prior to the dates of service on the claim.
  • 44Occupational Therapy - Oldest evaluation date & therapy type is OCCUPATIONAL. Date that treatment was started for therapy. This date is pulled from the earliest physical therapy evaluation date in the Evaluations screen and the date always remains the same for all visits tied to the episode.
  • 17:  Occupational Therapy - Most recent OCCUPATIONAL evaluation date based on DOS not already used AND Occurrence code 44 present (either manually or automatically from this list) Date the outpatient therapy plan was established or last reviewed. This is the closest evaluation or reevaluation date on or prior to the dates of service on the claim.
  • 45:  Speech Therapy - Oldest evaluation date & therapy type is SPEECH. Date that treatment was started for therapy. This date is pulled from the earliest physical therapy evaluation date in the Evaluations screen and the date always remains the same for all visits tied to the episode.
  • 30:  Speech Therapy - Most recent SPEECH evaluation date based on DOS not already used AND Occurrence code 45 present (either manually or automatically from this list) Date the outpatient therapy plan was established or last reviewed. This is the closest evaluation or reevaluation date on or prior to the dates of service on the claim.
  1. Next, input the Injury/Onset Date/Change of Status Date
  2. This date will display differently in the Extra Information section of AdvancedMD depending on the related cause/occurrence code populated by the selection of the Related Cause in the patient’s case in WebPT.
  3. When the Related Cause exists in AdvancedMD in the Extra Information from WebPT, the following Occurrence Codes could be generated:
    1. 01 Latest Date of Injury value
    2. 02 Most recent Date of Injury based on no-fault
    3. 05 Most recent Date of Injury without coverage
    4. 06 Most recent Date of Injury based on victim of crime
    5. To access the Extra Info Screen, see the above instructions.
    6. When the Related Cause is set to None of the Above/Occurrence Code 11 (in the patient’s WebPT case), the date will fill in the Date of Symptom/Illness box in the History section in the Extra Information instead of the Date of Injury box.
    7. (Upon claims generation in AMD, this will produce the Occurrence Code 11 on the claim if all other CORF components are present.)
  4. Set the Patient Status
  5. In AdvancedMD, this will appear in UB Information - Visit. Depending on the note type, the options available will change.

Resubmission Codes

The resubmission code flows into  Extra Information in AMD and derives its value from the note type in WebPT.

**2 is sent on Initial Evaluation and 3 is sent for all subsequent notes for UB insurance-type only**(4 is not currently used)