Release Highlights

RCM Enhancements

Configurable Type of Bill for Admit-to-Discharge Claims

What’s New: Billing administrators now have the flexibility to configure a custom Type of Bill (TOB) for UB04 claims that include all services from admission to discharge, directly within the Insurance Providers setup.

Why It Matters: This enhancement allows for greater customization of claim submissions, ensuring they meet the unique billing requirements of different insurance payers. By providing the ability to tailor the Type of Bill for admit-to-discharge claims, billing teams can better adhere to UB04 standards and payer-specific guidelines, reducing the risk of claim rejections or adjustments.

Who It’s For: Billing administrators and teams responsible for setting up and maintaining insurance billing configurations in facilities using UB04 claims.

How to Use It: In Billing > Insurance Providers, locate the new "Admit to Discharge" field under the Last Type of Bill section for both Inpatient and Outpatient areas. Enter the 4-digit TOB code specific to your payer’s requirements. This configured code will automatically apply to all claims that encompass services from admission to discharge, ensuring accurate claim coding for UB04 submissions.

Add Ability to Populate and Edit Box 40 on UB04 Forms

What’s New: Billing configuration specialists can now populate and edit Box 40 on UB04 forms, similar to the existing functionality for Box 39. This new section under the Service Business Rules enables users to configure value codes, enhancing claim submission flexibility and ensuring compliance with payer requirements.

Why It Matters: By providing control over Box 40, this update ensures that claims can be tailored to meet specific submission standards, particularly for GHR and other organizations using Office Ally and Waystar. This improves claim accuracy and supports seamless claim processing through these clearinghouses.

Who It’s For: Billing configuration specialists, particularly those working with GHR, who need to configure and submit UB04 claims with tailored value codes.

How to Use It: Navigate to the Service Business Rules section. Under Value Codes - Box 39, you’ll now find a new section labeled Value Codes - Box 40. Use this section to add Type, Code, and Value as needed for Box 40 on UB04 forms. Additionally, Box 40 can be manually edited if adjustments are necessary before submission.

Enhanced LOA Handling for Census and Billing at Midnight

What’s New: The system now automatically stops billing at midnight for any patient on Leave of Absence (LOA) and resumes billing the following day if the patient returns after midnight. This update also includes visual indicators and new filtering options to improve LOA management in the census.

Why It Matters: This enhancement prevents billing inaccuracies for patients who are temporarily on LOA by ensuring services are only billed when the patient is actively in care. The visual indicator and filtering options also make it easier for billers to track LOA periods and review billing records accordingly.

Who It’s For: Billing teams and administrators managing census and billing processes, particularly those working with facilities where patients may have temporary leaves of absence.

How to Use It:

• Midnight Check for Billing: If a patient goes on LOA before midnight and returns after midnight, billing will automatically halt for the LOA day and resume the next day. If the patient returns before midnight, billing will proceed as usual for that day.

• Census UI Enhancement: An orange bubble labeled "LOA" will now appear on the census for any day a patient was on LOA, even if for just a minute. Hovering over the bubble will display "Leave of Absence" and the LOA reason.

• Filter for LOA Patients: A new filter, "Show all patients with LOA during the week," allows users to view patients with LOA periods across all service facilities, weeks, and ‘Go to Date’ actions, making it easier to track patient status across different views.

EMR Enhancements

Leave of Absence Reporting

What’s New: Sunwave provides reporting related to what patients have been on a leave of absence.

Why It Matters: This enhancement provides historical and current reporting to help facilities understand when a client was on a leave of absence.

Who It’s For: This report is for operations, compliance, clinical and medical users who need to verify if a patient was on leave during a specific time period.

How to Use It: Ensure the user has access to reports. Navigate through Reports → Leave of Absence Report. Utilize to the To and From date fields to set the desired date range, specify Service Facility if necessary and press search. This report supports export to CSV.

Ticket Summary Table