The Billing Setup module ensures that your practice’s financial operations align with regulatory standards and payer requirements. It supports accurate claims, reduces denials, and enhances revenue cycle efficiency, whether for insurance setup, diagnosis codes, or CPT exclusions.
Some of the key sub-features of Billing Setup include:
Add Insurance:
TherapyPM allows you to add insurance companies and assign them to patient profiles for billing. To add/edit new or existing details, you can click on View Details button.
The following details are required:
Enter essential information – Insurance name, Payer ID, and contact information.
Choose between Primary, Secondary, or Tertiary insurance types.
Set claim formats and plan types.
Define billing preferences – Authorization Required, Paper/Electronic Claims.
It connects patients with the correct insurance setups, ensuring accuracy in billing processing. For more information, please visit this article!
Insurance Setup:
Manage and edit insurance details once you have added them.
You can add/edit the following details:
Search and filter existing insurance records
Edit/delete entries
View Payer ID/Claim Type/Status
Access insurance-specific settings for accurate billing.
This helps maintain clean and organized insurance data. For more information, please visit this article!
Add Treatments:
Add and manage treatment types offered in your facility. Create different treatment categories, assign code/name/description, and link treatments with specific service types and billing details. For more information, please visit this article!
Add Services:
Add specific services provided under each treatment type.
You can do the following:
Define each service with code, name, and duration.
Link services to the appropriate treatment category
Set default rates and unit types
Mark services as active/inactive as required.
Ensure all billable services are defined clearly, categorized well, and ready for use in session documentation and claims. For more information, please visit this article!
Add CPT Code:
Add CPT codes used for billing insurance claims.
You can do the following:
Enter CPT code number, description, and rate
Link CPT codes to relevant services and treatments
Specify unit time and set status – Active/Inactive
Ensure accurate and standardized coding for all billable procedures.
Ensure correct and efficient claims processing from insurance providers. For more information, please visit this article!
CPT Code Exclusion(s):
Manage CPT code exclusions to prevent specific combinations of codes from being billed together.
Select a primary CPT code
Exclude CPT codes that shouldn’t be billed with it
Ensure compliance with insurance rules and avoid claim denials
Maintain accurate and clean billing practices.
Reduce errors and improve reimbursement success with this feature. For more information, please visit this article!
Add Service Sub-Type:
Identify your service sub-types to categorize the services offered within your treatments. With this feature, you can:
Create custom sub-categories under the main services
Specify names and set them as active/inactive
Organize and enhance reporting clarity
Enable staff to select the correct service variations during session documentation.
With this feature, you can ensure flexibility and precision in tracking and billing services. For more information, please visit this article!
Billing Settings:
Configure general billing preferences that affect how billing operates across your system. With this feature, you can:
Set options – default billing method, session submission behavior, and timely filing limits
Enable/disable settings – auto-submission or allowing billing edits after submission
Customize how sessions are handled during the billing process.
Take control of how and when sessions are billed. Ensure everything aligns with your workflow and payer requirements. For more information, please visit this article!
Place of Service:
Manage and configure Place of Service (POS) codes used in billing claims.
With this feature, you can:
Add new POS entries by selecting a standard POS code and assigning a label
Activate/deactivate existing entries
Ensure accurate coding that matches where services were provided, for instance, office, home, or telehealth.
Set up POS codes properly to ensure insurance compliance and smooth claims processing. For more information, please visit this article!
Vendor Number Setup:
Add and manage vendor numbers required by some insurance companies for claim processing.
With this feature, you can:
Enter a vendor number linked to the specific insurance company and facility
Edit/delete existing entries
Ensure accurate and complete claim submission, especially for payers requiring vendor-specific information.
Setting up correct vendor numbers can prevent claim rejections, ensuring smoother billing operations. For more information, please visit this article!
Diagnosis Library:
Manage a list of commonly used diagnosis codes, such as ICD-10.
With this feature, you can:
Add new diagnosis codes along with their description
Organize and maintain a centralized library for quick access during billing or documentation
Ensure accuracy while assigning diagnoses to sessions or patients.
Streamline the billing process, enhance documentation consistency, and reduce errors in claim submissions. For more information, please visit this article!
Unbillable Activity:
Define and manage activities that are considered NOT billable to insurance or clients.
With this feature, you can:
Create entries for various non-billable tasks, such as documentation time, administrative work, etc.
Track time spent on these activities for internal reference or payroll purposes
Maintain clarity on which sessions or services are excluded from billing.
Monitor staff productivity, track workload, and ensure compliance with billing rules by separating reimbursable and non-reimbursable work. For more information, please visit this article!
OA Files:
Upload and manage Other Adjustments (OA) received from payers, such as:
Uploading documents related to payment adjustments
Keeping a record of files linked to claim rejections, denials, or balance write-offs
Ensuring transparent documentation of non-payment adjustments for billing review or audits.
Stay organized and don’t forget to keep track of all financial issues, while ensuring clarity. For more information, please visit this article!
SOP:
Upload or create Standard Operating Procedures (SOPs) related to billing tasks.
With this feature, you can:
Maintain internal guidelines for billing staff
Provide clear instructions for handling claims, rejections, and insurance processes
Ensure consistency and compliance across all billing-related operations.
Use this tool to onboard new billing staff while ensuring everyone follows processes uniformly. For more information, please visit this article!
Box 32 from POS Toggle:
It enables the option of Place of Service (POS) address for auto-filling Box-32 on CMS-1500 claim forms.
Turn ON the toggle to fill the address from the POS setup.
Turn OFF the toggle to use the default facility address instead.
For more information on how to populate the Box 32 flexibly, please visit this article!