Collaborative Care - Phases of Care - Billing Rules with Referrals

New Additions:

You are now able to specify whether or not you are able to bill in the following two circumstances:

• If a patient has been referred but not yet begun active treatment
• If the phase of care which is active for a patient at the end of the month is marked as allowing billing or not

This allows you to:

• Not bill for enrolled patients who are referred but not in active treatment
• Mark certain phases of care as not suitable for billing

This refers to the billing algorithm only, and has no impact on how Mirah bills for active patients.

By default, it continues to work as it previously did:

• Referred patients are billed
• All phases of care are billed

How to Change Billing for Referred Patients

When editing the billing algorithm, you may uncheck the “Bill Referred Patients Not In Active Care” option.

How to Change the Phase of Care to Not Allow Billing

In the phases of care editor, there is a new option “Allows Billing”. Uncheck this to stop billing for a phase.

Note that currently changing a phase of care to not allow billing will not automatically all current month results. In order to do this, replan the billing - e.g. edit the algorithm and save immediately to trigger, or use a support task.

Changes to Billing Insights

The billing details contain text explaining why you cannot bill.

If you cannot bill because of being in a referral state, you will see this icon:

If you cannot bill because the phase of care does not allow it, you will see this icon: