Explain to Me – Beaker Charging – Charge Bundler

For those who have experience with Epic Beaker, you will know that being knowledgeable in Beaker requires extensive application and integrated knowledge to be successful. This is because laboratories are not only integral in medical decision making, but also is specialized compared to other departments, such as laboratory billing.

As such, it is paramount that Beaker consultants have a firm understanding of how lab billing works to best support their clients in the near future. Due to the nature of the topic, we will be splitting this into multiple articles throughout the next few month.

What is the Charge Bundler

The Charge Bundler allows laboratories to control which charges are triggered in specific instances (charge bundles) and specific attributes about charges (charge attribute table). This provides the lab IT team the flexibility it needs to deal with the various nuances of lab billing, that used to previously be owned by the billing team.

Charge Bundles

Charge bundles are records that control what outbound charges should be triggered when specific criteria is met. Think of them as “If/Then” statements but for lab charges. Bundles can look at all charges triggered on a test, specimen, requisition, case, or within a specific time period for a guarantor and change the actual charges triggered based on the bundle build.

Two common use cases with bundles are for Medicare panels and Anatomic Pathology Stains.

  • Basic Metabolic Panel (Medicare Bundle): The BMP charge bundle can be used to combine all individual analyte charges into the single outbound 80048 CPT charge. Whether the charges are triggered as reflexes from your main BMP test or individually from each analyte test, the bundle will find them, cancel them, and then trigger the panel charge instead which will reduce your chance of claim denials.
  • IHC Stains (Anatomic Pathology): IHC Stain bundles are used to make sure the correct CPT code is triggered per specimen in a case. All stains should trigger CPT 88341 and bundles will convert the first 88341 per specimen to an 88342 to maintain compliance. This will reduce the amount of coding review required by your coding staff.
    • NOTE: Technical and professional charges cannot be evaluated together in a single bundle. Therefore you need to create separate bundles to check for each charges seperately.

There are a few things to consider when building your bundles.

  • Once you have your charge bundles created, they must be added to the Charge Bundler Profile. This record defines the order in which the bundles are triggered, and will not execute if it is not added.
  • The order they are listed in is very important. For example, if all the charges that make up a CMP bundle are triggered, but the BMP has a higher priority than the CMP bundle, the BMP charge (CPT 80048) will be triggered instead, and the analyte charges not part of the BMP will remain when all of them should have been combined into your 80053 CPT charge.

Charge attributes can be used to change the values of specific items on charges. These items are the performing department, encounter, diagnosis, billing provider, service provider, and date of service. You can choose from a list of pre-programmed values for each item or use a rule to return a specific value if the one you want is not in the list to choose from.

A common use case is to use an attribute to set the intraoperative pathologist as the billing provider for frozen charges. No longer will this need to be set via a charge router rule or manually changed in a workqueue, Beaker will make this change before sending the charge to the charge router.

The charge bundler gives your lab team ownership of build that was previously put on other teams. Epic’s Foundation System has a number of commonly used bundles that you can use to recreate in your system.

If you have any questions or are looking for additional help with your Charge Bundler build, reach out to us at [email protected].