Billing, Claims, & Rates
Is Exym is billing the LACDMH in units or minutes?
- We're billing in units, except for COS and couple of non-medical codes, which are in minutes per LADMH Guide to Procedure Codes.
What rate do we entered into the Taxonomy rate matrix?
- The hourly rate (except for COS).
What are the group formulas?
- [Taxonomy Hourly Rate] / 60 * [Minutes for 1 Unit] / 4.5 = [Per Unit Rate]
- [Per Unit Rate] * [Number of Units] * [Number of Participants] = [Group Total]
If you have additional questions, please open a ticket with an example activity ID and we can list out the group calculations in detail for that activity ID.
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.
Is there a way to prevent staff from submitting a note when it doesn't meet the minimum?
- Not currently; however, claims will be routed to CWPPI if they are not for enough minutes.
What is your suggestion of where to get the most accurate billing totals for FY 2023-2024?
- 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.
- The group calculations no longer divide by the amount of members in a group. All groups are divided by 4.5 now. You can learn more about group productivity calculations
Does travel have to be a new "program"?
- Yes, since this code needs to be billed with Non-Medical Funding source.
What billing rule are we to use for the travel time activity?
- Travel time activities need the CalAIM 2023 - LADMH County RuleCode. If you are unable to add it yourself, please create a support ticket so the Exym team can add it for you.
Do we need to go into the each client chart and individually add the non-MC funding source in the financial tab for whichever client we are going to be billing travel time for?
- Yes. Per DMH, the travel time is ONLY allowable for non-MC.