The below questions were asked at the 08/23/2023 LA County CalAIM Ask Me Anything (AMA) session. Answers provided may change based on new or updated guidance from DMH or future updates to the Exym system.
The below questions were posted 8/28/23. Other questions from the AMA are still in the process of being answered and will be added to this article once answered.
When we'll be able to send in COS claims?
- Nothing was changed with COS claims, other than the taxonomy rate matrix, so these should be invoicing. If they aren't, please create a ticket/respond to an open ticket with some activity IDs as examples.
When will the dual billers (not under group billing formula) be available to use?
- We will try get this done as soon as we can.
COS and OMA billing for our agency is appearing under the old Accounting > EDI > Ready to be Invoiced instead of the CalAIM billing tab. Why is that and can be move it to the CalAIM billing tab? Some other CalAIM claims are appearing on both tabs making it seem like they would be billed as duplicate if we create 837s under the Accounting tab.
- The CalAIM Billing tab is looking for activities with a CalAim rule code assigned. Since COS activities don't need the CalAIM rule code, they are under the old accounting tab. I will see if there is another way to do these in the future, but as of right now, they are in two separate tabs. The CalAIM Claims are also being worked on to have them removed from the old accounting tab. We are not billing them twice, we are billing what is on the new CalAIM Billing tab.
Is Exym working on being able to combine duplicate codes submitted on the same day into one claim?
- We're looking into this later. For now you'd need to combine the duplicate into one note.
We've seen various group claims where the group rate is not applied, resulting in incorrect amounts due.
- Please create ticket support and list the activities IDs so we can look into this.
If 2 or more clinicians meet with a single client, does the 4.5 group billing adjustment apply? For example, 2 clinicians providing a Plan Development H0032 service for a single client.
- Yes, since it's billed as a group. The 4.5 calculation will be applied to any activities that are billed as a group.
I am still not clear about non Medi-Cal claims. They are all denied because they need HX modifier. How does the HX modifier get added to the claim?
- The HX modifier is automatically added on the backend as long as the non-MC funding source is assigned on the client's financial screen.
I set up 3 separate note templates/activities for our LIC/REG clinicians in respect to therapy codes 90832, 90834, & 90837. I'd like to move to one CPT therapy note template where as you mentioned, based on Direct Care minutes Exym applies the appropriate CPT code. Should I submit a ticket or is there something I can do on the Admin+ side?
- You can deactivate the 90834 and 90837 templates and keep only the 90832 template.
I've seen claims where incorrect rates are being applied to calculate billing amounts. For example, full hour rates are being applied to units which equate to 15 minutes. This is very prevalent in our claims data. Is the system calculating claim amounts properly?
- We fixed the rate issue the week of 8/21. Please create support ticket so we can update claims in the back end that has incorrect rate applied.
I found out COS claims for FY23-24 are not included in the CalAIM activity Export, but only on the old export. Is there any way these claims can be added to the CalAIM export?
- We'll look into this and fix the report so COS can be included.
On what will productivity be based on the home screen? Units? Minutes will not make sense.
- We are looking into customize the report based on the customer need.
Are the CalAIM billing reports working?
- We do have some reports updated and ready to use. All reports listed under the NEW CalAIM Reports tab are updated.
What is your suggestion of where to get the most accurate billing totals for FY 2023-2024. We are 1.5 months into the FY and we still don't have a true handle on how much we've billed this FY.
- The Billable Services Export Unit Based and Activities (with Status in IBHIS) Unit Based reports should be able to give you an idea once you export them and filter the reports.
We are trying to measure staff productivity using billable minutes (direct time) using the billing services export report, but for groups, the time is not being divided by members in a group, leading to staff who do groups having inaccurate time. Are there any plans to change that or add another field?
- The group calculations no longer divide by the amount of members in a group. All groups are divided by 4.5 now.
What's the situation with Student at DCHS? Will Exym be storing these unsubmitted notes in Claims with Problems Preventing Invoicing?
- You'd need to put these notes on hold for now.
Is there a simple way to put approved notes on hold at the practitioner level? This way our clinical students' notes can be approved but not billed.
- We'll look into this and get back to you.
Is DMH already accepting the Travel Time notes?
- Not yet but you can have staff start to document them and be ready once DMH announced that they can accept travel claim
Can staff start submitting notes for travel time or should they be saved in draft? Will Exym automatically hold them?
- Staff can submit notes now. You can hold this code in the meanwhile waiting for LADMH.
Does travel have to be a new "program"?
- Yes, since this code needs to be billed with Non-Medical Funding source.
If we do not give clinicians access to the Travel program, would they not have the dropdown to select the program? We are thinking of having admin staff fill out the travel note.
- The services must be the practitioner that has the NPI since claims are being submitted thru 837P.
Can you remove/deactivate the field of "Other" "Travel" and "Documentation" and only leave the "Session" available?
- At this time, we can only disable other time IF travel and documentation time are enabled. We are working on correcting this, but don't have an ETA as of right now. Any values entered in these fields will not be calculated when the claims are created.
Regarding Travel Time notes - if they start doing them, will Exym hold them so they wont batch? Or do we ask our clinicians not to "submit" the note?
- We'd look into hold this claim. For now, you can ask the clinician not to submit or they can submit and you put on hold.
So whichever client we are going to be billing travel time for, we need to go into each client chart and individually add the non-MC funding source in the financial tab?
- Yes. Per DMH, the travel time is ONLY allowable for non-MC.