Billing Patterns
A patient list suggests the Schedule’s usual code for each patient each day. A billing pattern adds the way you bill on top: for example, K023 instead of the visit for a palliative patient after day 2, or K002 when you write “family” for a day. You set it up once and the whole list follows it.
You write the rules as plain sentences, such as “Patients tagged palliative, from day 3: replace the visit with K023 (the patient’s units).” Every suggestion is still checked against the Schedule, and suggestions never go past its limits (for example K121, at most 4 times per patient in 12 months): a code held back by a limit is shown on the day with the reason. Notes are warnings: you decide, and nothing is billed until you confirm it.
In the SnapBill billing app
Set up your own billing rules for your rounding lists in the SnapBill billing app at app.snapbill.ca. Creating an account is free.
Starting a Pattern
Open Patient lists, then Billing patterns. Three starters are ready:
| Starter | What it does |
|---|---|
| SnapBill default | The Schedule’s suggestions only. |
| Hospitalist MRP: palliative and mental health tags | On the admission day C003 with the MRP admission premium E082, with C912 offered as a swap (it needs a written referral and at least 75 minutes); on days 1 and 2 the visit, with K023 (palliative) or K005 (mental health) offered as a one-tap swap, since the Schedule doesn’t pay both the same day; after day 2, K023 or K005 in place of the visit; C142 and C143 the two days after an ICU transfer; G512 the first day and each Monday for palliative patients; add-on words for K002, K121, K730, A771, K038, K031, K035 and critical care time. |
| Covering physician | Subsequent visits without the MRP codes, premium or G512. |
A starter can’t be changed. Tap Make a copy to edit, or tap New pattern to start from nothing.
To use a pattern, open a list’s settings and choose it under Billing pattern, or tap Use on a list from the pattern itself.
Tags
Tag patients in the sheet’s Tags column (type them, separated by commas) or in their details: Palliative, Mental health, ICU, or a word of your own such as “dialysis”. Rules can then apply to tagged patients only. For ICU patients, also set the day they were transferred from the ICU. For time codes such as K023, set the patient’s units per day if it is usually more than one.
How a Day’s Codes Are Worked Out
Every day goes through the same steps, in order:
- Schedule ladder: the Schedule’s usual code for the day of stay (for example C122, C123, then C002, C007 and C009, C124 on the day of discharge, and the MRP premium E083 or E084).
- Your triggers: your rules, in order, for the patient’s tags, the day of stay, the ICU transfer, weekdays, and so on.
- Add-on shortcuts: the words you typed in the day’s add-on.
- Schedule checks: the claim check runs on the result. Its notes are warnings; suggestions never go past a Schedule limit.
Rules
A rule is one sentence: who it is for, which days, and what it does. For example:
- Patients tagged palliative, from day 3: replace the visit with K023 (the patient’s units).
- Every patient, weekdays: add K121, at most 4 per week.
- Patients tagged ICU, the day after the ICU transfer, not on the day of discharge: replace the visit with C142.
Writing a rule
Type the rule under Write a rule, in your own words or starting from an example, and tap Read it back. SnapBill shows how it reads it (“SnapBill reads this as: …”) and anything it could not read. Nothing changes until you tap Add this rule. If your wording was not the usual one, SnapBill says so and works out what you meant: check every part of the read-back before you add it.
To change a rule, click its sentence, edit the text and press Enter. You see the read-back again before the change is made.
Building a rule step by step
Tap Build it step by step under a rule (or Build a rule step by step for a new one) to set each part from a list:
| Part | Choices |
|---|---|
| For | every patient, or patients tagged (palliative, mental health, ICU, or a word of your own) |
| On | every day of care; the admission day; days 1 and 2; every day from day 3; a day of stay (is, is under, is over, is from … to …); the day of discharge; your first day with the patient; your first day for patients carried over; your first day, then each Monday; weekdays; weekends and holidays; certain days of the week; days after the ICU transfer; days the add-on says a word. Add not on the day of discharge to leave that day out. |
| Then | add; replace the visit with; offer as a swap for the visit (the day shows “Bill … instead” and nothing is billed until you swap); leave out; just show a caution |
| Codes and units | each code with its units: a set number, the patient’s units, or the minutes in the add-on (half hours as in GP55, or quarter hours for critical care as in J26) |
| Limit | no limit of your own, or at most N a day, a week (Monday to Sunday), per stay, or in 12 months |
The sentence and the steps always match: change one and the other follows. Advanced holds the rarer parts: more conditions, codes to leave out as well, and the MRP premium (follows the visit, or none). Show a caution adds a reminder of a condition to be sure of before billing.
A rule’s own limit counts your claims, the days you have confirmed and the earlier days on the list. Once it is reached the rule stops adding the code (a rule that replaces the visit keeps the visit that day), and the day says so. The Schedule’s own limits apply anyway.
Use the arrows to change the order, the switch to turn a rule off, and the cross to delete it.
The whole pattern as text
Choose View as text to see and edit the whole pattern as plain text: one rule per line, in order, then the add-on shortcuts (lines starting with “Add-on”). Tap Check every line to read each line back, then Apply to use the lines that read. Lines that could not be read stay marked so you can fix them; a line in unusual wording is used only once you tick that you have checked its read-back. Save keeps the pattern.
Add-on Shortcuts
The add-on box on each day turns your words into codes. Write a shortcut like a rule (“Add-on ‘family’: K002.”), or list the words and the codes they add in the Add-on shortcuts table. Separate several items in one day with commas:
| You type | With the Hospitalist MRP starter |
|---|---|
| family | K002 |
| family x2 | K002 ×2 |
| case conf | K121 |
| race 30 min | G521 + G523 |
| race 50 min | G521 + G523 + G522 ×2 |
| family 50 min | K002 ×2 |
- “x 2”, “x2” or “2x” after a word sets the units.
- “30 min” sets the units for time codes: half hours for codes such as K023 and K005 (20 minutes is the first unit, then 46, 76 and so on, GP55); quarter hours for critical care, G521 for the first, G523 for the second, then G522 for each one after (J26).
What Set Off Each Code
Every suggested code says what set it off: Schedule ladder for the Schedule’s own suggestion, a tag such as Mental health or Palliative, an add-on word such as Add-on word ‘family’, or Weekly for a once-a-week rule. Point at a code on the sheet, or open the day, to see it with the reason and the Schedule page.
How this pattern bills, in the pattern, and How this list bills, beside each list’s sheet, show the pattern as cards grouped by trigger: the Schedule ladder, one card per tag, the ICU transfer, weekly codes, and the add-on shortcuts with an example of each (“family” bills K002, “race 50 min” bills G521 + G523 + G522 ×2). Each sentence shows its codes, limit, Schedule pages and cautions; rules you switched off are greyed. On a list, each card says how many patients and days it fired for and how often a limit held it back; click a card to highlight those days on the sheet. In the pattern, click a card to mark its rules.
Rounding Periods
If you round in blocks, set the list’s rounding period in its settings. My first day is the day your rules treat as “your first day with the patient”: a patient admitted before it counts as carried over from a colleague, and once-a-week rules start from that day. The Schedule’s visit ladder still counts from admission.
A list can also wait until the end of the period to bill: confirm the days as you go and bill the block at the end. Your pattern keeps working on confirmed days, so a tag added later updates them. See Billing at the end of the period.
Try It Before You Use It
At the top of How this pattern bills, choose one of your lists and its rounding period (or a week). The pattern is tried there as soon as you open it, and again when you tap Try on this list after a change. Each card then shows what it did on that list, and any Schedule checks its codes ran into; See the days shows each patient’s codes day by day. Nothing is saved or billed. Tap Save when you are happy with it, and Use on to switch the list to it.
Good to Know
- A rule changes what is suggested, never what the Schedule pays. The Schedule check still runs on every day.
- Changing or deleting a pattern does not change claims already created. Lists using a deleted pattern go back to SnapBill default.
- Rules don’t apply to a day already billed, except to add codes such as an add-on from a keyword.