How do I add/edit/disable Bill Codes?

Bill codes determine how visits and premiums are billed to specific funders. Once created, you can then add bill codes to service codes and premiums. 

Invoicing can be done through ACC or items can be exported to an external billing system through a billing export. 

Each bill code has a rate attached that indicates how much will be billed to a Funder. For example, if your agency provides private service for $18/hour, you can set up a bill code at a rate of $18, and then link it to your private pay funder.

To view, add, edit, or disable a bill code, go to Accounting > Accounting Settings > Bill Codes.

• Add a Bill Code
• Search for a Bill Code
• Edit a Bill Code
• Disable a Bill Code
• Bill code form fields

Add a Bill Code

1. Go to Accounting > Accounting Settings > Bill Codes. 

2. Select + Add Bill Code.

3. In the dialog, fill in the appropriate fields. See explanations of each form field. 

Add Bill Code dialog. Please note different configuration options may appear depending on previous selections. 

Notes for Coordination of Benefits (COB):

• For patients participating in the COB program, where the primary payor is a professional type and the secondary payor is an institutional type, you can capture the Revenue Code in this step specifically for professional claims.
• The entry fields for professional claims will appear in this dialog when you select a professional-type funder.
• Filling in the revenue code field ensures institutional claim compliance. The collected information is sent to the secondary payor, supporting adherence to the COB claim requirements.

4. To confirm the bill code creation, Save.

⚠ After saving a bill code, you can no longer edit the Funder and Units. This prevents data-related problems later on in the billing process. ⚠

Search for a Bill Code

To search and filter, select the filter icon. You can filter by status, and funder, and search by code or name. 

Edit a Bill Code

To edit a Bill Code, select Edit. Make your changes, and Save. 

⚠ Editing a bill code will make no difference to existing invoices. ⚠

Disable a Bill Code

To disable a Bill Code, select Disable on the dropdown. ⚠ Disabling a bill code will not affect any prior uses of the bill code. It only prevents it from being available as a possible selection going forward. ⚠

Bill code form fields

Below is a list of all possible form fields available when you add or edit a bill code. Different configuration options will appear depending on previous selections you have made. The fields available also depend on whether the bill code is set up for Electronic billing or for Private Pay. 

Form field	Context or how to fill it out
Summary
Code	Create a short name for the bill code. It will be displayed to staff throughout the application. For agencies that use an integration with another software, this code should match their requirements.
Name	Create a name that displays on client invoices. It should be client-friendly.
GL Revenue	Revenue account against which this bill code should be logged in the General Ledger. If you only have one revenue account created in your Chart of Accounts, it will already be selected here.
Funder	Choose a funder for the bill code. Each bill code can only have one funder.
Professional Claims > Billing Increment	Choose the amount of time that makes up a billable unit when generating claims for the bill code. Applies to Electronic Billing.
Professional Claims > Send Decimal Units	If checked, the exact unit value of the visit will be used, rounded down to two decimal places. Selecting this option will bypass any bank settings associated with decimal units. For example, if you configured a 60-minute Billing Increment (see line above), and the visit is 45 minutes, the system will send 0.75. Applies to Electronic Billing.
Professional Claims > Place of service code	Select a code that represents where a service occurred. Applies to Electronic Billing.
Professional Claims > Revenue Code	Enter the revenue code, a universal code that holds information about a patient's treatment, or services performed by healthcare providers. Accommodates the Coordination of Benefits payor program where the primary payor is a professional type, and the secondary payor is an institutional type. Filling this out ensures institutional claim compliance by using the revenue code on the professional-type bill code. The captured information is then forwarded to the secondary payor. Applies to Electronic Billing.
Institutional Claims > Billing Increment	Choose the amount of time that makes up a billable unit when generating claims for the bill code. Applies to Electronic Billing.
Institutional Claims > Send Decimal Units	If checked, the exact unit value of the visit will be used, rounded down to two decimal places. Selecting this option will bypass any bank settings associated with decimal units. For example, with this option selected, if you configured a 60-minute Billing Increment (see line above), and the visit is 45 minutes, the system will send 0.75. Applies to Electronic Billing.
Institutional Claims > Facility Code	Select a code that represents where the visit took place. Applies to Electronic Billing.
Institutional Claims > Revenue Code	Enter the revenue code, a universal code that holds information about a patient’s treatment, or services performed by healthcare providers. Accommodates the Coordination of Benefits payor program where the primary payor is a professional type, and the secondary payor is an institutional type. Filling this out ensures institutional claim compliance by using the revenue code on the professional-type bill code. The captured information is then forwarded to the secondary payor. Applies to Electronic Billing.
Institutional Claims > Revenue Code Description	The Revenue Code description that will be sent on the claim. Applies to Electronic Billing.
Institutional Claims > Value code	Select from a list of defined values that apply to this bill code, such as the number of days not covered by the primary payor or Medicare Lifetime Reserve days. Applies to Electronic Billing.
Institutional Claims > Value code amount	Apply a value to the Value Code you have selected. Applies to Electronic Billing.
EVV Settings > Service Group	The Service Group is used for certain EVV aggregators and will be sent with the EVV submission. Applies to Electronic Visit Verification.
EVV Settings > Category	The Category is used for certain EVV aggregators and will be sent with the EVV submission. Applies to Electronic Visit Verification.
EVV Settings > Rate Code	The Rate Code is used for certain EVV aggregators and will be sent with the EVV submission. Applies to Electronic Visit Verification.
Ruleset	Select any bill code rules you previously set up in Accounting Settings > Bill Code Rules.
Taxes	If you have configured any taxes under Accounting Settings > Taxes, you can add them here.
Excluded from Billing	This is unchecked by default. If you check this option, any visits or premiums with this bill code will never appear in an invoice. For example, supervisor visits or other internal-only services may not need to be included in the invoice.
Split visits into two billable items at midnight	If checked, and the visit end time is past midnight, per-hour visits will be split into two billable items to respect possible configured rate changes.  Choose between these options: Use exact bill quantity When selected, billable items split at midnight will carry the exact quantity of each item. Example scenario: A visit occurred from 11:40 PM to 12:40 AM, with a Minimum Billing Duration of 1 minute. Billable item #1 Use rounding rules When selected, billable items split at midnight will round the quantity based on the Rounding Rules configured for Visit Verification.
Split visits based on holiday configured times	When the bill code unit is per hour, you will see this option available to split visits based on holiday configured times. Selecting this option will generate multiple billable items for visits that cross over holidays.
Use Clocked Time for Billing	If checked, the invoice will display the visit’s clock-in time as the start time, and the visit’s clock-out time as the end time. If left unchecked, the invoice will display the scheduled time of the visit.
Rate Setup
Rate method	Select Fixed Rate to set pricing at per rate, per visit, or per hour. It is the most common billing practice. Select Tiered Rate to set up units and rates for a specific visit duration, charging different amounts at different time increments.
Default Rate	Set the default rate for the bill code. Enter up to four decimal places.
Units	Choose the unit of measure for the bill code rate. If the bill code rate should be billed by the hour, select per hour. If the bill code rate should be billed by the visit, select per visit. If the bill code rate should be billed at a flat rate, select per rate. Billing at a flat rate should be used for items that are billable premiums, such as parking or reimbursement. For example, a rate of $1.00 can be entered and multiplied against a quantity to reflect the total billable amount. In this case, a caregiver could be reimbursed $15.00 for parking, if you enter 15 in the premium quantity. ⚠ Select per visit if you charge a flat rate per visit. Select per rate if your organization charges a flat rate for service. ⚠
Default Rate ID	This optional field allows you to assign a unique ID to a rate. If you do not fill it in, the system will autogenerate one.
Effective Date	This represents the date the bill code becomes effective. Only visits and premiums created as of this date will be subject to the rate you are configuring. Multiple rates can be added and will come into effect based on the date.
+Add Time Specific Rule	Time Specific Rules allow you to set different rates based on certain times of day or days of the week. For example, if visits are billed at a higher rate on weekends, you can configure those details here. More info: How do I define time specific rates for bill codes?
Split visits into multiple billable items based on time specific rates	If checked, a visit that falls between different Time Specific Rules can be split into multiple billable items. Applies only to per hour bill codes.
Rounding Rules
Minimum Billing Duration (minutes)	The minimum duration in minutes that you wish to bill for a visit. Once configured, when a visit goes through Visit Verification, and the actual visit duration is less than the minimum billing duration set in this field, the minimum billing duration will take precedence. For example, if you have set the minimum billing duration as 30 minutes, a visit from 11:15 AM to 11:27 AM will be considered 30 minutes long for billing purposes. Please note this functionality requires Visit Verification.
Rounding Rule	Rounding Rule determines how a visit’s bill quantity should be rounded during Visit Verification. Select whether the visits linked to this bill code should be rounded to the scheduled time or the clocked time. Scheduled Time Clocked Time – Total Duration Refers to the total duration of time that the caregiver clocked in, which is then rounded. Clocked Time – Start and End Times Start and end times of the clock-in are rounded separately. Applies only to per hour bill codes. More info: How do I create rounding rules for bill codes and pay codes?
Rounding method	If you selected Clocked Time in the Rounding Rules field, you can choose a rounding method. No Rounding Round Up Round Down Round to the Nearest Threshold Refers to rounding based on a customized period of minutes (for example, 53 minutes out of an hour).
Rounding Increment (minutes)	If you selected any rounding methods other than Threshold, choose a rounding increment in minutes.
Rounding Threshold (minutes)	If you selected Threshold under Round method, select a rounding threshold based on a customized period of minutes. For example, if the Rounding Threshold is set to 53 minutes, and the Rounding Increment is set to 60 minutes, a visit that is 52 minutes or less in duration would round to 0 minutes for billing purposes—and cannot be billed at an hour. If the visit is 53 minutes or longer, it would round up to 60 minutes, meaning a whole hour can be billed.
Breaks	If you selected Scheduled Time under Rounding Rules, choose whether to include or exclude the break time from the invoice calculation.

 

Learn more

• How do I create rounding rules for bill codes and pay codes? 
• How do I set up electronic billing in AlayaCare?
• The Relationship between Service Codes, Pay Codes, Bill Codes, and Funders
• How do I set up/edit/disable a Funder?
• How do I set up/edit/disable Taxes?
• How do I add Billing Premiums for my Clients?
• How do I set/edit/clear a custom bill code rate for a particular client?