Adding and modifying billing items (service codes) to provincial bills (New Brunswick)

⚠️ Important: This is currently a beta feature. It will be available once the beta period is complete.

Whether you're billing from an encounter, the Visits dashboard, or 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. Start a bill from an encounter, from the Visits dashboard or from the patient's chart. If you're editing a bill, open the bill from the Billing dashboard.

To create provincial bills from an encounter, click Insured Billing.
To create provincial bills from the patient's chart, click +New Payment.

To create provincial 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.

💡 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.

The New or Edit NB Billing Item window opens.

2. Using the following table, complete the applicable fields.

Field	Description
Code / Description	1. To search for the service code: By code, in the first search field, start typing the code. By description, in the second search field, start typing the description. 2. In the list of matches, select one from the list. 📌Note: Two service codes, 888 (No precise item in schedule) and 75 (New service request) require a custom description. In the window that appears, enter the description and click Save.
Units	The number of units sent to New Brunswick Medicare determines the amount that is charged to the patient, not the dollar-based amount. The Units are those in effect on the service date; the Fee amount is calculated by multiplying the Units, the number of services (Count), and the rate for the provider’s specialty. You can change the units, if necessary in special circumstances, but not the fee calculated. Only whole numbers are accepted in the Units field.
Override Calculations	Each service code is associated with default units that automatically populate when you enter a service code. If you need to change the units, for example, when New Brunswick Medicare updates a fee code but the change has not yet been reflected in the CHR, you can override them. 📌Note: When you change the units, the Override Calculations checkbox is selected and the field Units changes to Units to be billed.
Count	Indicates the total number of times that a service is billed for on a claim. For example, when a patient visits a provider twice in the same day for the same issue (typically because the issue worsened), you claim both visits on the same bill.
Based on Service Code	If a service code requires a secondary code, the system enables the Based on Service Code field and a list of service codes to choose from appears. When you select a code, the number of units updates according to the Based On Service Code percentage. For example, service codes 9111, 8288, and 2634.
Manual %	To reduce the fee by a percentage in the drop-down, select the percentage. For example, if this is the second service you're billing for and it's billed at 50%.
Service Modifier	The CHR uses the modifiers in conjunction with the fee code to determine the amount payable. 📌Note: The list only includes modifiers that can be used with the selected fee code. For this reason, always enter the fee code before you select a modifier from the list.
Surgical Modifier	Click the field and select Different Incision or Same Incision.
Service Location	The Service Location defaults to your primary service location where you rendered the service, e.g. Office or In-patient. To modify it, select a different location from the list. 📌Note: Service Location and Medical Site are not linked to the Location field selected in your claim.
Medical Site	The Medical Site is the actual building where the patient received the services. Select the building name from the list. 📌Note: Service Location and Medical Site are not linked to the Location field selected in your claim.
Diagnostic Code	Enter the diagnostic code, or start typing a description to search for and select the code from the list. Another search field appears, prompting you to enter another diagnostic code. Enter another code or click inside the Edit NB Billing Item window to exit the search field. You can add up to five diagnostic codes. 📌 Note: Any diagnostic codes you record in the encounter’s Assessment and Plan section is pre-populated for you in your bill. Refer to Syncing diagnosis codes.
Diagnosis Description	If necessary, click and type supplemental information that outlines the specific condition or illness diagnosed in a patient.
Service Date	If you started the bill from an encounter associated to an appointment or from the Visits dashboard, the Service date matches the appointment date. If you started the bill from the Insured Billing area of the patient's chart, the date defaults to the date you created the bill. ⚠️ Important: The Service Date is submitted to New Brunswick Medicare as part of the claim and should match the date in the New or Edit Insured Payment window and in the Edit NB Billing Item window. To change the date, click the calendar icon and select a date, or enter the date in the field.
Start Time and End Time	Enter the Start Time and the End time into the corresponding fields. 📌Note: The Start Time and End Time fields are not automatically populated from an appointment or encounter. To change a time, click the clock icon and select a time, or enter the time in the field.
End Date	If the service provider offered a time-based service and ended it on a different date than the start date, click the calendar icon and select a date.
Time Spent	To calculate the time spent, enter the Start Time and End Time. Otherwise, enter the amount of time in minutes in the Time Spent field. 📌Note: Time Spent is not automatically updated or taken from the encounter or appointment.

3. Select Show Advanced Fields to view additional fields.

Field	Description
Admission Date, Discharged Date, Last Date Charged and Date Taken	When billing for hospital visits, click the calendar icons to select the dates. Admission Date - the date the patient was admitted to the hospital. Discharged Date - the date the patient was discharged from the hospital. Last Date Charged - the date the patient was last seen for services rendered over a period. Date Taken - the date the service/procedure was performed. Example: The date the radiology film was taken.
Service	Referring Practitioner If applicable, type the name or billing number of the provider who referred the patient to you. If the referring practitioner is listed, a code and description appears. For more information, refer to Adding a referring provider to a provincial bill. 📌Note: When you create a bill, CHR contacts are not used to find the Referring Practitioner. Referral Date - Click the calendar icon to select the date the patient was referred to/from another service provider. Referral Type - Select Referred To or Referred From from the list. Rotation - Indicates that the billing service provider was covering an assigned on-call shift. Select the code from the list.
	Prior Approval - Enter the number provided by New Brunswick Medicare for an approval request to determine coverage. Newborn (A, B, C, etc. ) - When more than one baby is born, for example,triplets. A stands for the first one born, B for the second one born, C for the third one born, and so on. Select one from the list. 📌Note: Create one bill per child.
	Canceled Surgery and Reason If surgery was cancelled, select the Cancelled Surgery checkbox and under Cancelled Surgery Reason, select one from the list: Contamination, Problem with facility, Shortage of beds, Shortage of equipment, or Shortage of personnel.
Premiums	Independent Consideration Select when you want New Brunswick Medicare to consider certain service codes. 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. After Hours Emergency, Cancer Premium, Midnight to 7 am, Time Exception, On Call If you are working after hours or under special circumstances, select the appropriate checkbox and a premium is applied to the bill. Refer to Applying extended hours premiums to bills. 📌 Note: The Start Time field in the fee item must be correct. If the fee code requires it, the system prompts you to enter the Start Time and Time Spent. Override Rules Select if you need to override the rules for fee codes, diagnosis required, referral required and gender restrictions.
Immunization	You can only populate this field if the service code allows it. For example, service code 8647. Product Name - Select immunization details from the list. Vaccine Lot Number - Select the lot number from the list.
Anesthesia	Anesthesia Time Enter the length of time anesthesia was administered in minutes. Anaesthetic Modifiers Select a modifier from the list.
Other	Comments You can add additional comments. Attachments Click +Add attachment to provide additional medical documentation to your claim. You can add up to five attachments (.txt, .jpg, .jpeg, .pdf, .doc) with a maximum size of 8MB. 📌Note: When you link a patient file to a fee item, the NB Billing* tag is automatically assigned to the file, the file is locked, and users cannot make any further edits.

4. To save or update the billing item, click outside the Edit NB Billing Item window. The service code is added to or updated in the bill.

Updated August 21, 2024