Custom Report Mappings

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Use this menu to find the map that you want to modify, and then click Show. The map appears in the View Data section.
3. To add a new row, or mapping, to the custom report map, in the Add Data section, enter the data for each required field, and then click Add. The map in the View Data section displays the new mapping.

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Use this menu to find the map that you want to modify, and then click Show.
3. Custom Report Map Owner — If "None specified" appears below this field, click Update.
   A text box opens.
   
4. Enter the athenaOne username of the owner of this custom report map.
5. Click Update.

Note: If the username of a map owner is displayed, you can use the Update link to change the username.

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Use this menu to find the map containing the values that you want to modify, and then click Show. The map appears in the View Data section.
3. Locate the row, or "mapping," that contains the values that you need to modify, and click update. The section directly above the map changes its heading to Update Data, and the values from the mapping you selected appear.
4. Change the values as necessary, and click Update. The changes you made to the values are reflected in the mapping.

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Select Per Diem Rates, and then click Show.
3. Scroll down to the Add Data heading.
4. INSURANCEREPORTINGCATEGORY — Select the correct insurance reporting category.
5. DEPARTMENT — Select the FQHC or RHC department.
   Warning: Do not select the All Departments option.
6. STARTDATE — Enter the start date for charging the new per diem rate.
7. ENDDATE — Enter the end date for charging the new per diem rate.
8. DAILYRATEAMOUNT — Edit the per diem rate for this department.
9. Click Add.

Note: If a per diem rate changes, you must add a new row for the new rate and enter the start and end dates for the new rate. If the per diem rate for an FQHC or RHC department will remain unchanged for the coming year, update the end date.

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Select Per Diem Rates and then click Show.
3. Scroll down to the View Data heading.
4. Click update for the FQHC or RHC department for which you expect per diem payment from Medicare and Medicaid.
5. INSURANCEREPORTINGCATEGORY — Verify that the insurance reporting category is correct.
6. DEPARTMENT — Verify that the department to update is correct.
7. STARTDATE — Edit the start date, as needed.
8. ENDDATE — Edit the end date, as needed. If the rate remains the same from the previous year, extend the ENDDATE.
9. DAILYRATEAMOUNT — Edit the per diem rate for this department, as needed.
10. Click Update.

You can create custom RVU values for specific procedure codes and edit existing custom RVU values. These values are used to calculate the custom RVU values in the RVU report.

Note: To configure a large number of procedure codes, click Download as CSV file at the bottom of the page. Use the CSV file as a template to enter all data, and then return this file to your Customer Success Manager. Your entered custom values are uploaded to this page.

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Select Custom RVU Procedure Values, and then click Show.
3. Scroll down to the Add Data heading.
4. PROCEDURECODE — Enter the procedure code for which you are assigning a custom RVU value.
5. EFFECTIVEDATE — Enter the date that the custom RVU value will be in effect for the specified procedure code. Any transaction with a service date on or after the effective date will use this custom RVU value for the specified procedure code.
6. EXPIRATIONDATE — Enter the date after which the custom RVU value is no longer in effect for the specified procedure code. Any transaction with a service date after the expiration date will not use this custom RVU value for the specified procedure code.
7. WORKRVU (Number) — Enter the base custom work RVU value to use in determining the custom work RVU value in the RVU report.
8. FACILITYRVU (Number) — Enter the base custom practice expense RVU value to use in determining the custom practice expense RVU value in the RVU report. This value is used when the CMS place of service type for the service department associated with the charge is considered a facility.
9. PERVU (Number) — Enter the base custom practice expense RVU value to use in determining the custom practice expense RVU value in the RVU report. This value is used when the CMS place of service type for the service department associated with the charge is not considered a facility.
10. MALPRACTICERVU (Number) — Enter the base custom malpractice expense RVU value to use in determining the custom malpractice expense RVU value in the RVU report.
11. Click Add.

You can create custom RVU adjustment values for specific modifiers and edit existing custom RVU values. These values are used to calculate the custom RVU values in the RVU report.

Note: To configure a large number of modifiers, click Download as CSV file at the bottom of the page. Use the CSV file as a template to enter all data, and then return this file to your Customer Success Manager. Your entered custom values are uploaded to this page.

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Select Custom RVU Modifier Adjustments, and then click Show.
3. Scroll down to the Add Data heading.
4. MODIFIER — Enter the modifier for which you are assigning a custom RVU adjustment value.
5. EFFECTIVEDATE — Enter the date that the custom RVU value will be in effect for the specified modifier. Any transaction with a service date on or after the effective date will use this custom RVU value for the specified modifier.
6. EXPIRATIONDATE — Enter the date after which the custom RVU value is no longer in effect for the specified modifier. Any transaction with a service date after the expiration date will not use this custom RVU value for the specified modifier.
7. ADJUSTMENT (Number) — Enter the adjustment rate to use for the CMS standard RVU values or the custom RVU procedure values that you configured (using the Custom RVU Procedure Values option). The RVU values are multiplied by this adjustment to calculate custom RVU amounts.
8. Click Add.

1. Display the Custom Report Mappings page: On the Main Menu, click Settings > Practice Manager. In the left menu, under Practice Links — Reports, click Custom Report Mappings.
2. Map Name — Select the map that you want to delete and click Show. The map appears in the View Data section.
3. Under View Data, find the mapping that you want to delete, and click delete. A warning appears.
4. Click OK. The mapping that you deleted no longer appears in the map.

The Report Map Validation Errors report identifies validation errors in the custom report mappings. Instructions for resolving these errors are included on the report run page; you resolve the errors on the Custom Report Mappings page.

To add this report to the Report Library, go to the Activate Reports page and select Report Map Validation Errors. The report appears on the Other tab of the Report Library.

Note: For athenaEnterprise clients, the Report Map Validation Errors (Cross Practice) report can be enabled. This report is useful for complex tablespace setups that involve many practices.

To activate the Report Map Validation Errors report, you must have the Report: Custom Reports Activate permission and one of these roles:

• Management – Collector
• Superuser – Collector
• Finance – Collector
• Clinicals Superuser

athenaOne uses mapping tables to store the contracted Medicare and Medicaid per diem rate information used when posting FQHC and RHC claims. Each mapping table establishes the per diem rate for a given insurance reporting category for each department that bills using a per diem rate.

Note: It is your responsibility to keep per diem information current. To update your per diem rate information, select Per Diem Rates from the Map Name menu on the Custom Report Mappings page.

The Claim Formatting & Financial Insight [FQHC] report uses the per diem rate mapping table. In the report, the sum of the per diem rate and additional charges (as specified in the claim scrub data) provides the expected payment amount for the FQHC or RHC claim.

You can run the RVU report to display a list of transactions with their customized RVU values. Each row in the RVU report corresponds to a charge transaction, with the exception of subtotal rows.

Tip: athenahealth recommends that you include only those fields needed for your report. Each additional field selection slows down the generation of the report.

The RVU report is primarily intended for use with the customized RVU values that you configure using the Custom Report Mappings page. You may want to create custom RVU values in the following scenarios:

• CMS defines an RVU value for a particular procedure code, but you want to apply a value to that procedure code that differs from the CMS value.
• CMS does not have a defined RVU value for a procedure code (the code is "unlisted"), and you want to assign an RVU value to that procedure code.
• You want to specify a custom adjustment value for modifiers used in your charge entry.

For instructions on configuring custom RVU values for procedure codes and modifiers, see the Custom Report Mappings page. After the customized RVU values are configured, the RVU report calculates the RVU values automatically.

For more information about RVUs and RVU components, see Relative Value Units (RVUs).

Custom RVU values and modifiers

 

CMS specifies RVU values for:

• Stripped CPTs (CPTs with no associated modifier)
• CPT/fee-affecting modifier combination

Note: CMS uses these standard fee-affecting modifiers: TC, 26, and 53. These modifiers can be associated with a procedure code in your fee schedule or you can add them (as an "other modifier") during charge entry.

 

athenaOne assigns the CMS RVU values to a charge by first checking for a fee-affecting modifier and then verifying whether a defined CMS value exists for the CPT/modifier combination. If the charge has no fee-affecting modifier or if CMS does not specify any RVU values for this CPT/modifier combination, athenaOne uses the stripped CPT to select the RVU values.

 

When you run the RVU report, athenaOne works with modifiers as follows.

1. If the charge has a fee-affecting modifier, the report looks for the exact CPT/modifier combination in the Custom RVU Procedure Values map on the Custom Report Mappings page and uses the associated RVU values.
2. If the Custom RVU Procedure Values map on the Custom Report Mappings page does not contain the CPT/modifier combination, or if the charge has no fee-affecting modifier, the report looks for an exact match of the procedure code and uses the associated RVU values.
3. If the Custom RVU Procedure Values map does not contain the CPT/modifier combination or the procedure code, the report looks for the stripped CPT (removing all associated modifiers).
4. If the Custom RVU Procedure Values map does not contain the stripped CPT, the report uses the standard CMS RVU values.
   Note: If CMS does not define RVU values for the particular CPT, the report returns a value of zero.