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Module 3: Modifiers, creating a custom billing code, and changing & adding billing codes

As a US Biller, there are 5 learning modules for you to walk through before you get up and running with Jane’s insurance features:

Learning Modules Complete
1. Setting up insurers, billing codes, and billing info 🥳
2. Claim submissions & management 🥳
3. Modifiers, creating a custom billing code, changing and adding billing codes ✍️
4. Remittances
5. A/R tracking (aging claims)

 

💡Jane Tip: We recommend heading over to Jane’s Demo Clinic to practice as you learn! Log in as the ‘owner’ profile for Full Access to the features we’ll be talking about. You can find the login password to access the Demo Clinic by heading to the Jane Community Group on Facebook and clicking the ‘Featured’ tab. If you’re having any trouble, you can also request the password by email ([email protected]).


While you may not be the primary person entering billing codes for appointments, it is still very important to understand where these codes are being generated from, how they work, as well as how we can manipulate them to ease some of the work done when it comes to posting remittances for the clinic’s claims.

In this module, we’ll be running through everything you need to know about:

Preparing the Appointment for Claim Submission

Note: Speed up or slow down the video speed using the ⚙️ button inside the video player!

To prepare an appointment invoice for EDI claim submission, the date of service will need to have at least one billing code and diagnosis code added, as well as the patient’s insurance policy added.

Adding CPT & Diagnosis Codes to a Visit

First up, let’s take a look at how to add CPT/Diagnosis codes to a visit for insurance billing or superbill creation.

Let’s say Victoria books in for a visit at our Demo Clinic. When Victoria arrives at the office, a staff member will Arrive the visit in Jane.

Arriving the visit will generate an invoice for the default Treatment price, $50 in this case. You can ignore this invoice price for now, as any CPT fees will override this treatment price.

The provider has now treated Victoria and is ready to proceed to check out.

The provider will need to add in the CPT and Diagnosis codes that apply to the patient’s visit. CPT & Diagnosis codes can be added to the Insurance Info section of the appointment by searching and selecting their desired codes.

This information can be entered in two ways by the practitioner while charting from the Day view:

Here are the steps to adding CPT & Diagnosis codes:

  1. From the Practitioner Day View, double click the appointment to view the Appointment window (or click on an appointment from the Schedule view.)
  2. Scroll down to the Insurance Info section
  3. Search for the applicable CPT code in the “Add Billing Code” search bar

In this example, we add a billing code with an assigned rate of $65. This will override the $50 treatment price, and Jane will bill the patient $65 instead.

💡Pro Tip: If you press the Space bar on your keyboard when adding billing codes to a purchase, Jane will show you all of your favorite codes.

Once you have added in the CPT code(s), the provider can add the diagnosis code(s) to each CPT code added to the visit.

💡Pro Tip: If multiple billing codes need to be added to a visit, and each billing code needs to have the same list of diagnosis codes, then you can start by only adding one billing code and all of the diagnosis codes for the visit under that billing code.

Once you’ve added all of the diagnosis codes to your first billing code, Jane will automatically add the diagnosis codes that were added to that first billing code to all subsequent billing codes that you add.

Once the diagnosis codes have been added to the appointment, the provider can either generate a superbill if Victoria is a Cash patient or move on to add a claim to the visit if Victoria has coverage.

For more info on generating superbills in Jane, please have a look at our Creating Superbills guide.

Adding Modifiers

Modifiers can be added right below the diagnosis area by just typing them in:

You’ll need to press the Enter button on your keyboard to save the modifier. You’ll see the little “X” next to the modifier if it has been attached to the billing code properly.

If you’ve added this modifier in the past, Jane will show it as an option that you can select from.

Here’s a quick example:

As you can see, once a modifier has been used, Jane will remember that and recommend any previously used modifiers the next time you’re adding these to claims.

Practice Drill 🏈

Hop on to the Demo Clinic to do this next exercise!

Instructions:

  • Start by heading into the Schedule tab and clicking on an appointment to open the Appointment Panel.
  • Scroll down to the Insurance Info section and enter in a CPT code
    • You can do this by typing in the codes number, or a keyword.
  • Once the CPT code is listed, enter a diagnosis code beneath it.
  • Next, add a Modifier beneath the diagnosis code(s).
  • Finally, we can correct the billing code by selecting the dropdown menu and choosing to Change Billing Code. Simply type in another billing code and voila!

Touchdown! 📣


Re-booking Clients with the Same Insurance Info

Need to book in a patient for a subsequent visit where all (or most) of the Insurance Info will be the same?

If so, whoever is booking the appointment can copy that information over either at the time of booking or after the patient has booked in to save some time. This applies to both cash and insurance patients.

We’ve got this handy guide that covers all the details: Re-booking Clients with the Same Insurance Info.


Way to go! Another module is complete. Let’s take a look at getting paid in our next Module: Module 4: Remittances.