Billing
Charge review
Work the charges your finalized visits create: release clean ones, fix or pend held ones, and create claims.
Every finalized visit sends its treatment lines to billing as charges. A charge is one billable line: the code with its modifiers, the units, the price from your fee schedule and the payer it bills on the date of service. Open Billing in the main menu, then Charge review in its panel, right after the billing home; it lists the charges waiting for review.
How charges are created#
When a note is signed (and co-signed, if the visit needs it), NeatPractice creates one charge per treatment line:
- Payer: the patient's primary coverage on the date of service. A patient with no active coverage, or a self-pay primary, is billed as self-pay.
- Price: the standard fee schedule rate for the code, location and modifier on the date of service, and the expected allowed amount from the payer's fee schedule. Both are kept on the charge, so later fee schedule changes never change it.
- Modifiers: the clinician's modifiers come first, then your modifier rules add discipline, telehealth, assistant and KX modifiers, up to four per line. Distinct-service modifiers such as 59 are only suggested.
- Diagnoses, providers and authorization come from the visit and its episode of care.
If a visit is corrected with an addendum that changes billable fields, a charge that is not billed yet is replaced with a new one built from the corrected visit. Payments, write-offs and transfers already posted on the old charge, such as a check-in copay, move to the new one, so the patient is not asked to pay twice. A charge that is already on a claim is marked Visit changed after billing so you can correct the claim.
Statuses#
| Status | Meaning |
|---|---|
| Draft | Created and clean, waiting for a reviewer to release it. |
| Held | Waiting on a hold (see below). |
| Ready | Released and ready to go on a claim. |
| Billed | On a claim. It can no longer change here. |
| Voided | Removed from billing, kept on record with the reason. |
| Non-billable | Time the payer does not pay, such as an overlap it denies (concurrent services). Never billed; payroll still pays it. |
| Settled outside claims | Paid directly by another party, so it is never billed. Final; see Settle a charge outside claims. |
Holds#
NeatPractice checks each charge when it is created and again when you release it or build claims, so a hold lifts on its own once its cause is fixed.
| Hold | What to do |
|---|---|
| Awaiting co-signature | The note or an addendum still needs the supervisor's co-signature. |
| No fee schedule rate | Add the code to your standard fee schedule. |
| Missing claim consents | Record the release of information and assignment of benefits consents in the chart. Paper payers are not held. |
| KX attestation missing | The patient passed the Medicare therapy threshold. The therapist attests medical necessity on the plan of care. |
| Missing authorization | The payer requires an authorization for this service and none covers it. |
| Provider not enrolled | The payer requires enrollment and the rendering provider is not enrolled on the date. |
| Plan of care not certified | The payer requires a signed or verbal physician certification. |
| Units over MUE | The units of the code for the day are above the Medicare limit. |
| Units over payer cap | The units are above a cap in the payer's code rule: per note, per day, per week or per episode. |
| Billable condition not met | The payer bills sessions only after the caregiver signs or an analyst reviews the note (billable condition). |
| Assessment report not ready | The visit counts toward an ABA assessment whose report is not signed yet. |
| Documentation signed late | The note was signed after its deadline and the clinic holds charges of late notes. |
| Documentation overdue | A documentation deadline that holds billing has passed and its note or signature is not done yet. It lifts on its own once it is done. |
| Group size out of range | Fewer or more patients attended the group session than the code allows. |
| Awaiting QA review | The payer waits for QA and a QA rule sent the note to the QA queue. It lifts once a reviewer approves the note. |
| Audit findings open | The note has audit findings and either the payer holds charges with open audit findings or a failed audit rule holds charges. It lifts once they are fixed, overridden or disputed. |
| Pended | A reviewer pended it with a reason and follow-up date. |
| Returned to clinician | A reviewer sent it back to be corrected with an addendum. |
Pended, Returned to clinician, Missing authorization, Provider not enrolled, Plan of care not certified, Units over MUE, Units over payer cap, Assessment report not ready, Documentation signed late, Group size out of range, Awaiting QA review and Audit findings open can be released with a reason. The others block the release until they are fixed.
Review a charge#
Click a charge's date of service, or choose Review in the row's actions, to open the charge. The Review tab shows the visit, the price and any holds or warnings. You can change the modifiers, the units and the diagnosis pointers while the charge is not billed. Changing the units needs a reason (the field turns required as soon as the units differ), units take at most two decimals, and they cannot exceed what the visit's minutes support under the payer's unit method. Each charge points to one to four diagnoses; the form says which rule is broken until it is fixed. The History tab lists every change, release and hold with who made it.
From the buttons at the bottom of the dialog, left of Close:
- Release moves the charge to Ready. When an overridable hold stands, NeatPractice lists the holds, marks which the release clears (a pend or a return to the clinician) and which it overrides, and asks for a reason.
- Pend keeps it in review with a reason and an optional follow-up date.
- Return to Clinician holds it and notifies the rendering provider to correct the visit.
- Void removes it from billing with a reason. A charge is never deleted. Payments posted on it go back to their payment's unapplied credit, ready to apply elsewhere, and its write-offs and transfers are reversed.
- Settle Outside Claims (in the more actions menu, on a Ready charge) records that another party paid it directly. See below.
Each of these asks for its reason in a dialog that names the charge (patient, chart number, date of service, code, amount and payer), so you can confirm the row before you act. Pend, Return to Clinician and Void are also in each row's actions.
Settle a charge outside claims#
Sometimes a service is paid without a claim, for example by an agency or another party that pays the clinic directly. Open the Ready charge, or its row's actions, and choose Settle Outside Claims. Pick the adjustment type the remaining balance is written off under and say who paid and why.
The charge becomes Settled outside claims: it never goes on a claim, and its History keeps who settled it and the reason. What its first payer still owed (the patient's share when the charge is self-pay) is written off with an adjustment of the chosen type, which shows in the charge's payment history. An adjustment above its type's approval limit waits for an approver. To undo the write-off, reverse the adjustment; the charge itself is never edited or deleted. You need permission to review charges and to manage adjustments.
Filters and bulk actions#
Click Filter above the table to narrow the queue by date of service, payer, provider, status or hold. The queue opens on the charges in review (Draft, Held and Ready), oldest date of service first; remove that status filter to see billed and voided charges too. Pick patients in the patient panel to see only their charges, or providers on its Providers tab to see the charges they rendered; the status and other filters stay as they are. Click a column header, such as Amount or Payer, to sort by it. Select rows to act on several charges at once:
- Release moves the clean ones to Ready.
- Recheck Holds works the automatic holds out again right away, for example after you filed a missing consent or a provider's enrollment was approved. Holds whose cause is fixed lift; pended and returned charges stay held.
- Reprice gives charges still in review the rates of the fee schedules in force for their date of service, after a fee schedule change. Billed charges are never repriced. Each change shows in the charge's History.
- Create Claims builds claims from the ready ones (see Claims).
Each action counts only the selected charges it applies to. When none apply, for example Release on a charge that is already Ready, the action is unavailable and says why. When only some apply, the action shows how many, such as Create Claims (2 of 3), and skips the rest. The Holds column lists every reason a charge is held, one per line.
Charges of a school or agency payer are not claimed: they go on an agency invoice.
Rate sync#
When rates change, open the page's menu and click Rate Sync. It lists the unbilled charges whose amount differs from the fee schedule in force for their date of service, with the current and the schedule amount. Narrow the list by discipline or payer, then either select charges and click Update Charges, or click Update All Differences to update every unbilled charge that matches the filters, beyond the rows on screen (up to 20,000 at a time).
Updates run in the background, so you can close the dialog and keep working. Past syncs shows each sync's status and how many charges it has checked so far; one sync runs at a time. When a sync finishes, download its file of every charge's amounts before and after. If a sync stops partway, the charges it already updated keep their new rates and its file lists them. Billed charges are never changed.
Release clean charges automatically#
In a payer's billing rules, turn on Release clean charges automatically to skip review for that payer: charges with no holds and no warnings become Ready as soon as the visit is finalized.
Payment history#
In a charge's header, choose Payment History to see what has been posted to it: payments, adjustments and moves between payers and the patient, with what each payer and the patient still owe. See Adjustments. You need permission to read payments.