Split Billing Overview

If you haven't already done so, please read the Billing Rules Overview topic before continuing!

Summary

"Split Billing" refers to the situation in which most of the items for a particular visit, such as a Workers' Comp injury visit, are billed to one party (e.g. the insurance company) while one or two services, such as a drug screen, get billed to get billed to another party (e.g the lab or employer). You can set up instructions in the software so that the program will remember to split the bill appropriately. Once the instructions are set up properly, you will never have to be concerned again that the bills are correct, nor will you have to do anything else (after the setup is complete) to make this happen.

Sometimes, users will confuse split billing with alternate bill-to addressing. A split bill occurs when part of a bill is paid by one account and the rest by another account. That is to say, the services are paid for by completely different parties. Alternate bill-to addressing occurs entirely within a single billing account when the program takes certain visits or certain activity and creates an invoice which is separate from the primary invoice going to that account. (In spite of the name, "alternate bill-to address", the invoice might or might not go do a different contact or address.

There are two ways to enter the instructions for split billing:

• Company Specific Protocol. When activities are added to a company protocol you can indicate an override payer. This is almost always how drug screens on Workers' Comp visits are handled, since insurance carriers rarely pay for substance abuse tests. Typically, the company will be the override payer, but sometimes a lab will be. When a split billing rule is entered on a protocol it affects only that single activity on that specific type of visit.

• Third Party Services Contract. When a company is set up, a services contract can be entered which splits the billing for all activities included on the contract to a third or fourth party, such as a contract TPA. When the contract is entered, a list of activities can be added, and special pricing might or might not be applied. Every time an activity which is on the contract is provided, it is billed to the third party, regardless of the visit category A classification of visit types for purposes of (a) tracking utilization of your department; (b) determining what screens and buttons to display in the visit record; and (c) defining treatment protocols for physicals. If you are part of an Occupational Health Clinic that is using STIX for billing, the Visit Category also determines how the visit will be billed .

It is possible to set up split billing on a generic protocol, but we strongly recommend against it!