Billing Overrides

In this Article 

1 
Modifier Override
2 
All insurance Provider Override
3 
Specific Insurance Provider Override

The purpose of Overrides within Heno is to allow the practice to set up automation for billing procedures.

1 

Modifier Override

When using a Modifier Override, there are two main settings that be be done.
  • Override if the Modifier in Box 1 is Blank
  • Override a Modifier that is present

    • Override if the Modifier in Box 1 is Blank

  • This will allow you to set a modifier for a specific provider without having to add it to every fee schedule within Heno. Heno will review the provider and apply a modifier into the check out screen when the CPT code is selected
    • The set up for this will start inside the Billing tab -> Manage -> Overrides:

    Click Create in the upper right hand side of the screen

    In the pop-up, you will select the first option Modifier #1 Based on Rendering Provider and follow out the following information:

  • Red - Rendering Provider: This is the provider you want this function to automatically add the modifier for
  • Blue - Old Value: Leave this as "Is Blank"
  • Green - New Value: Select the Modifier you would like to automatically populate for this provider

    • You will be able to see the change happen within the check out screen as you are entering in CPT codes.


    Override a Modifier that is present

  • This will allow you to set up insurance information (such as GP modifier on your Medicare insurance) and have it override to the correct Modifier by the provider treating (such as GP to GO for an occupational therapist). This will prevent having to create multiple insurance companies or plans and will automatically update the in check out screen
    • The set up for this will start inside the Billing tab -> Manage -> Overrides:

    Click Create in the upper right hand side of the screen

    In the pop-up, you will select the first option Modifier #1 Based on Rendering Provider and follow out the following information:

  • Red - Rendering Provider: This is the provider you want this function to automatically add the modifier for
  • Blue - Old Value: Select the Modifier that is present in the insurances (Such as GP on Medicare)
  • Green - New Value: Select the Modifier you would like to automatically populate for this provider

    • You will be able to see the change happen within the check out screen as you are entering in CPT codes.

    2 

    All insurance Provider Override

    This setting will allow you to set up an automatic override to Change the rendering provider from one provider to another with different document signature options for all insurances.

    When using an All Insurance override, there are three main reasons this would be done.

  • PTA needing a PT to be the billing provider with signature on the document 
  • Student being observed by a PT and document needs to be signed and billed under treating provider
  • A provider who is not credentialed and billing needs to go out by another provider 
    • **Please Note: This is for automation and will allow the action to fully complete without another persons review. Depending on your practice, this will work for you or you may be interested in the  Therapist 2  settings

    The main set up for this will start inside the Billing tab -> Manage -> Overrides:

    Click Create in the upper right hand side of the screen

    In the pop-up, you will select the Second option Rendering Provider - All Insurance and follow out the following information:

  • Red - Rendering Provider - Old: This is the treating provider on the document and provider on the check out screen.
  • Blue - Rendering Provider - New: This is the rendering provider that the billing will be switched to for claim submission 
  • Green - Signatures to Print on IE/DN/PN/DC: You will have 3 options to pick from in this section:
    • Both: This will place both provider signatures on the final document (Treating and Billing)
    • Old: This will only populate the Original (Treating) provider signature on the document, but will still correct the billing provider
    • New: This will only populate the Billing provider signature on the document and correct the billing (Treating provider signature will not be present)
    • This will reflect the provider check in the Encounter (Pre-Claim) area once the appointment has been Checked Out
    This will also show on the document based on the settings that were selected for the signature:

    a60fe4b0014579f616fdc4b26ad24316.png

    3 

    Specific Insurance Provider Override

    This setting will allow you to set up an automatic override to Change the rendering provider from one provider to another with different document signature options based on the insurance

    When using an All Insurance override, there are three main reasons this would be done.

  • A provider who is not credentialed and billing needs to go out by another provider 
    • **Please Note: This is for automation and will allow the action to fully complete without another persons review. Depending on your practice, this will work for you or you may be interested in the  Therapist 2  settings

    The set up for this will start inside the Billing tab -> Manage -> Overrides:

    Click Create in the upper right hand side of the screen

    In the pop-up, you will select the Second option Rendering Provider - All Insurance and follow out the following information:

  • Red - Rendering Provider - Old: This is the treating provider on the document and provider on the check out screen.
  • Blue - Rendering Provider - New: This is the rendering provider that the billing will be switched to for claim submission 
  • Green - Signatures to Print on IE/DN/PN/DC: You will have 3 options to pick from in this section:
    • Both: This will place both provider signatures on the final document (Treating and Billing)
    • Old: This will only populate the Original (Treating) provider signature on the document, but will still correct the billing provider
    • New: This will only populate the Billing provider signature on the document and correct the billing (Treating provider signature will not be present)
  • Orange - Insurance
    • Select a single insurance that this override is set up for

    • You will also have the option to Select Multiple insurances at one time

  • Pink - Show Multiple Insurances
    • Select Multiple Insurances that this override is set up for (Moving the insurance from the Left side of the shuttle to the Right)

    • This will reflect the provider check in the Encounter (Pre-Claim) area once the appointment has been Checked Out
    This will also show on the document based on the settings that were selected for the signature:

    a60fe4b0014579f616fdc4b26ad24316.png