⚠️ Important: Before you can bill Health PEI through the CHR, your user account must be integrated with Health PEI.

Whether your billing from an encounter, from the Visits dashboard or from the Insured Billing area of the patient's chart, the process for adding billing items (service codes) to a bill is the same. From the Billing dashboard, you can also open bills and modify billing items as long as the bill's status allows you to edit the bill.

Steps

1. To create provincial bills from an encounter, click Insured Billing.

2. To create provincial bills from the patient's chart, click +New Payment.

3. To create bills from the Visits dashboard, click Add Insured Payment.

When creating bills from the patient's chart or Visits dashboard, a New Insured Payment window appears. Click + Add Fee Item.

πŸ’‘ Tip:

If you previously created billing items for the specific patient and you want to use the same codes, click the clock icon next to +Add Fee Item and select a billing item from the list.

For encounters click the clock icon next to Insured Billing.

The Edit PEI Billing Item window appears.

4. Using the below table, complete the applicable fields:

Field

Description

Code / Description

  1. To search by code, start typing the code in the first search box.

  2. To search by description, start typing the description in the second search box.

    Matches are displayed

  3. Select one from the list.

πŸ’‘ Tip: To save the code to your favourites, select the star icon next to the specific code. Every time you create a bill, the starred favourites appear first in the Code/Description search list.

⚠️ Important: You can only search service codes linked to the provider's Specialty, unless you select Override Rules under Show Advanced fields. See Overriding CHR billing rules when creating provincial bills.

Base Amount

The fee amount of the code you selected is automatically populated.

πŸ“Œ Note: Some fee code amounts are calculated based on an equation. Therefore when you increase the Count, the amount will not double.

To see the equation, hover your cursor over the displayed EQ.

Count

If the code requires time units or number of services, type the number in the field, or click the up/down arrow.

Override Calculations

If you want to change the Base amount. For example, when a fee code has been updated by Medicare but does not yet reflect in the CHR system.

  1. Select Override Calculations.
    Base Amount changes to Amount to be billed.

  2. Under Amount to be billed, change the amount.

See Overriding fee amounts when creating provincial bills.

Role

You must select a Role when billing certain fee codes. Select the role indicating the percentage of the base amount to bill if different to the default 100%.

πŸ“Œ Note: There are certain procedure fee codes that you can bill at a reduced percentage, e.g. when you are a first or second surgical assistant billing for a procedure.

Diagnosis Codes

Enter the diagnosis code, or start typing a description to search for and select a diagnosis code from the list.

Another search field automatically appears, prompting you to enter another code/description. Enter another code or click inside the Edit PEI Billing Item window to exit the search field.

πŸ’‘ Tip: To save specific diagnostic code to your favourites, select the star icon next to it. Every time you create a bill, the starred favourites appear first in the list.

When billing from an encounter and you added a diagnosis code in the Assessment section of the encounter, it is pre-populated for you.

πŸ“Œ Note: Any diagnosis codes you record in the Assessment section of the encounter, is pre-populated for you in your bill.

Service Date

The date defaults to the date you create the insured bill.

If you started the encounter associated to an appointment, the Service date is associated to the appointment.

⚠️ Important: This service date is submitted to Health PEI (Medicare) as part of the claim.

To change the date for the specific billing item, click the calendar icon.

Time Spent (Minutes), Start Time and Finish Time

The start time defaults to the time you create the insured bill.

If you started the encounter associated to an appointment, the Start time is associated to the appointment. The Time spent (minutes) and Finish time is associated to the appointment type.

To change the time for the specific billing item, click the clock icon.

⚠️ Important: Some service codes are time-based. The CHR automatically calculates and applies the correct Base Amount based on the Time Spent.

Facility Type and Facility

These items default to what has been configured for your account.

To change, select the fields and choose the applicable Facility Type and Facility (name of the facility) from the lists.

Referred By

  1. Select if you the provider saw a patient that was referred to them.

    The Referred By section expands.

  2. Enter the Name and Number (billing number) of the referring provider, or click the magnifying glass to search for the provider.

    πŸ“Œ Note: If a referring provider is recorded in patient demographics, the provider is automatically pulled into the Referred By field.

Referred To

1. Select if you are a General Physician (GP) and referring the patient to another provider.

The Referred To section expands.
πŸ“Œ Note: Depending on the service code entered, this is often automatically selected.
See Billing for out-of-province referrals

2. Enter the Name and Number (billing number) of the provider, or click the magnifying glass to search for the provider.

Show Advanced Fields

Select to add additional information:

Admission and Discharge Date

When billing for hospital visits, click the the calendar icons and select the correct dates.


New Born Mother PHN

When billing for a newborn visit, type the mother's personal health number in the field.


Responsible for Pay
If you are salaried and doing fee-for-service work, click PEI Medicare (default) and select Other.
⚠️ Important: You must click Edit Comment and type a comment in the yellow text box, e.g. FFS billing outside salaried hours. See Billing fee-for-service as a salaried physician.


Emergency
If you are working after hours select this checkbox. An after-hour premium is added to the bill. See Applying after-hour premiums to bills.
πŸ“Œ Note: The Start Time field above must be correct.


Independent Consideration

This is automatically selected when certain service codes are used.

Select if you want Health PEI to consider certain service codes. It must be accompanied with an explanatory note. Click Edit Comment and type your explanation in the yellow text box in the Comments window.

For example, you see a patient for post-surgery complications but you were not the surgeon who performed the procedure. You bill certain codes that are normally billed together.


Work related


Accident


Override Rules

Select this checkbox if for example you are working in a capacity other than your stated Specialty. You can then bill any code and not specialty specific, e.g. you can use the code 0113 as a GP but not as a surgeon. See Overriding CHR billing rules when creating provincial bills.

5. To save your changes, click outside the Edit Billing Item window. The service code is added to the bill.

πŸ’‘ Tip: Click a billing item to edit or delete it.

Created December 23, 2021

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