Service Item Setup and Management

Service type invoice items are used for billing purposes. The invoice item type determines how revenue is tracked through service vs. inventory sales reports. Service items can also be added to group codes and pick lists. When creating or modifying service items, be sure to review the tabs to ensure complete setup.

Setup a service item

New Items

1. Accept, modify, or enter an appropriate Item ID up to 7 alphanumeric characters, and press the Tab key.
2. Select Service.

Information tab

1. Enter or modify a hospital description up to 40 alphanumeric characters. This description appears in the Invoice Item List, reports, and in the patient’s record.
2. Enter or modify a client description, if applicable. This step is only necessary if the client description differs from the hospital description. This description will appear on invoices, estimates, prescription labels and reminders.
3. Select or modify the primary classification. A subclass can also be selected, if applicable.
4. Enter or change the revenue center ID or press F2 to search and select from your revenue center list if using item level center assignments.
5. Scan a sell barcode, if applicable.
6. In the type area, make selections as appropriate:
   • Status indicate as active or inactive
   • Miscellaneous item allows modification of the description when added to estimate, Patient Visit List (PVL) or invoice or prescription.
   • Display on Vaccine Tab when invoiced, item will appear on the vaccine tab in the patient history section of the Patient Clipboard.
7. Enter a minimum price, if applicable, to prevent the selling price from dropping below a certain threshold
8. Enter an estimate markup, if applicable. This automatically calculates a high price entry when creating estimates.
9. Enter a Base Amount. This price appears in the Price column in the Invoice Item List.
   • Enter tiered pricing quantities and amounts, if applicable. Quantity pricing information appears when you click the Price button in the Invoice Item List.
   • When entering tiered pricing, the amount field is multiplied by the quantity to arrive at the final price.
10. Select the appropriate Allow Change setting to determine when the price of an item can be changed on an estimate, PVL, or invoice:
    • Always: No restrictions on who can or when the price can be changed.
    • Never: No one except an administrator can change the price.
    • Only increases: Price can only be increased, except by an administrator.
    • Only with a reason: A reason as to why the price is being changed is required. Set reasons up under Controls > Price Change Reasons.
    • Require change: A price change will be required upon saving or posting an estimate, PVL, or invoice. Use this for items that have a price of $0, so as not to forget to enter the price.
11. Click OK to save your changes or proceed to another setup tab.

Instructions tab

Departing instructions print on the invoice based on the items invoiced. For example, notes on medication interactions, advice on what to expect following a vaccination, cautions for reactions, etc. To setup departing instructions, navigate to Lists > Departing Instructions.

1. Enter departing instruction ID or F2 to search and select from your departing instruction list. Repeat as needed for additional instructions.
2. To remove a departing instruction, click the ID field and press Ctrl + D.

Prescription instructions are used to automatically populate the Instruction field on a prescription label. These instructions can be modified at time of use. To set up prescription instructions, navigate to Lists > Prescription Instructions.

1. Enter a prescription instruction ID or press F2 to search and select from your prescription instruction list. Only one prescription instruction can be linked to an item at a time.
2. To remove a prescription instruction, clear the ID field and press the Tab key.
3. For Veterinary Pharmacy Reference integrated practices only: The Pharmacy link information area allows you to link and configure this invoice item to its applicable medication in the pharmacy formulary.
4. Click OK to save your changes or proceed to another setup tab.

Reminders tab

• There are two types of reminders available in Cornerstone:
  • Letter-type reminders are used for the majority of reminder activities, like postcards, emails, and texting services, and appear on the Reminder Letter reports.
  • Call-type reminders are used to populate call backs on the Daily Planner and appear on the Reminder Recall report

• Reminders should be set up to satisfy sequential and interchangeable items. For example:
  • The first FVRCP vaccine reminds for the second FVRCP vaccine in the series.
  • The final FVRCP vaccine in a series reminds for the annual FVRCP.
  • The rabies 3-year item satisfies the rabies 1-year item and vice versa.
• Invoice items automatically satisfy reminders generated for themselves, including call back type reminders. For example:
  • A patient has an annual exam reminder. When invoiced for the same annual exam, the old reminder will be satisfied and the new one will be generated on the patient record for one year from the date it was invoiced.
• Service items that may benefit from reminders include:
  • Examinations like annual, senior, or rechecks.
  • Vaccination series.
  • Post-op progress calls.
  • Laboratory test monitoring.

1. In the Reminders to generate area, right-click > New.
2. Enter the Item ID or press F2 to search and select from the Invoice Item List.
3. Select the reminder type. Tip: Use a generic call back item ID in cases where a direct item reminder to generate will also satisfy for itself. This retains the call back reminder in the patient file after the invoice is posted.
4. For reminder timing, do one of the following and click OK:
   • Select Ask for months/days in invoicing to prompt for the specific reminder date in invoicing.
   • Enter the number of Months or Days after the item is invoiced to generate the reminder.
   • Repeat steps for additional reminders to generate as needed.
     To modify or delete an existing reminder, right-click > Update or right-click > Delete.
5. In Letter reminders to satisfy area, right-click > New.
6. Enter the Item ID or press F2 to search and select from the Invoice Item List and click OK.
7. Repeat steps for additional reminders to satisfy as needed.
8. To modify or delete an existing reminder, right-click > Update or Delete.
9. Click OK to save your changes or proceed to another setup tab.

Tax/Disc tab

Link or remove taxes and discounts to invoice items at the item level. The Mass Markup Tool can be used to apply or remove taxes and discounts across all items or multiple items based on item type and classification.

1. Select the Sales Tax(es) to apply. Taxes are set up under Controls > Taxes.
2. Select the discount(s) to apply. Discounts are set up under Controls > Discounts.
3. Click OK to save your changes or proceed to another setup tab.

Link Items tab

Add quantity tracking inventory items to be depleted when the related service item is billed. For example, a 4Dx test service is linked to a SNAP 4Dx Plus test.

1. Enter the ID of the item or press F2 to search and select from the Invoice Item List. 
2. Enter the quantity of the item to deplete when the primary item is invoiced.
3. Repeat the steps to link additional items as needed.  
4. Click OK to save your changes or proceed to another setup tab. 

Special Actions tab

Special Actions are additional activities that help automate workflows, such as printing a document, issuing a vaccine tag, or initiating a lab request when the billed item is added to a PVL or invoice. The following actions are available

• Image Request
• Lab Request
• Mark the Patient Deceased
• Prescription label
• Print Document
• Sex Modification
• Update Vital Signs
• Update Microchip ID
• Vaccine Tag

1. Select the special action.
2. Select when to apply the special action. When to apply options vary based on special action:
   • Optional on invoice: When Post is selected on the invoice, a Special Actions window will display with the option to process the special action.
     
   • Before invoice is posted: The Special Actions window automatically displays when Post is selected on an invoice.
   • Immediately on invoice/PVL: The Special Actions window automatically displays as soon as the item is entered on a PVL or invoice.
   • Print after invoice posted: This option is for documents only.
3. Add specific details as needed:
   • Image Request: Select modality, enter an exam description, if applicable.
   • Lab Request: Select a lab profile:
     • Double-click in the profile description field to open the Profile List.
     • Select the lab from the drop-down list.
     • Clear the Only profiles that can be requested check box.
     • Search for and select the profile
   • Print Document: Enter a document ID or press F2 to search and select from a list of documents.
   • Update Vital Signs: Enter number of days existing weight is considered current to prompt the user to update the patient’s weight and vital signs
4. To remove an existing action, select the action and click Delete.
5. Click OK to save your changes or proceed to another setup tab.

Travel tab

If using travel sheets, add or remove items individually from the invoice item setup. Manage travel sheets and add/remove multiple items under Lists > Travel Sheets.

1. Click on the travel sheet name to add or remove the item from the travel sheet.
2. Click OK to save your changes or proceed to another setup tab.

Whiteboard tab

If using the Electronic Whiteboard, you can set default values and rules for items used to place Patient Orders. Multiple items can be set up using the Invoice Item Setup Tool’s Whiteboard tab.

1. Select a default field type listed in the Patient Order defaults area.
2. Specify the default value to use for the field, as applicable. Choose <None> to require the user to update at time of use.
3. Select appropriate rule for When this default is changed on the Patient Orders window setting:
   • Also change the above default – the changed value becomes the new default value for this field.
   • Do not change the above default – the default value is retained.
4. Select the appropriate Editing permissions setting:
   • All staff may edit for no staff restrictions when editing a patient order.
   • Only staff with security permissions may edit to require Whiteboard Orders Override security permissions to edit a patient order.
5. Repeat the steps above for each Patient Orders field for which you want to set up defaults and change rules.
6. Click OK to save your changes or proceed to another setup tab.

Additional information

Info tab

• Item IDs:
  • Item IDs can be changed using the Change IDs Tool under Tools.
  • Some practices benefit from grouping IDs by class to align with the AAHA chart of accounts.
  • Use sequential item IDs for related products to simplify entering of Item ID ranges for reporting.
    • Ex: 5010 is revenue category or exams. Exam ID’s could look something like:
      • 50101 Medical Exam
      • 50102 Progress Exam
      • 50103 Annual Exam
• Descriptions:
  • Use consistent descriptions and classification assignments for efficient item search and reporting.
  • Modifying an item’s description or changing its assigned classification will not change past patient history or reporting. Classification changes are best made immediately after an end of month close so an item is not listed in both prior and current classification in same monthly report.
• Items can be inactivated if no longer needed. If the item is used in other item setups, like group codes, pick lists, reminders to generate or satisfy, linked items, or travel sheets, a list of related item IDs will display. Remove the item from the item setups and then inactivate.
• Item type can be changed to inventory if setup as a service in error. If changing the item type, review all information per tab for any other needed modifications.
• Revenue Center can be left blank if the associated classification has an assigned revenue center, or if your practice is using billing staff or logged in practice for revenue center selection.
• Minimum price is used for billing until the quantity multiplied by the base price exceeds the minimum price.
• Use of Miscellaneous should be minimal.
  • If item has both a hospital and client description and selected as Miscellaneous, when used, the client description is bypassed and the modified description will be on the client invoice, estimate, prescription label.
  • Modified descriptions for billed and prescribed items will appear in patient history, and for billed items only on the Patient History report.
  • Modified descriptions are not displayed on reports.

Instructions tab

• You can add, modify or delete departing instructions for the patient at time of invoicing.

Reminder strategy examples

Service item series

Service item indirect reminder strategy

Service Item: Direct with cross reminder

Service Item: Direct reminder

Reminders tab

• If the billing invoice item ID is same as its reminder to generate, you do not need to enter as a reminder to satisfy. This reminder will satisfy itself, including call back type reminders.
• Only service and inventory type items can be used to generate or satisfy reminders.

Tax/Disc tab

• When setting up a new item, some taxes or discounts will already be highlighted if they are selected as defaults: Controls > Defaults > Practice and Workstation > Invoice Item.
• If using Petly Plans automated discounting, the related discount cannot be modified.
  • It is recommended to remove any previous 100% discounts from plan items to avoid discounting unavailable items for active plan participants or applying discounts in error to non-plan participants.
  • For more details, refer to Petly Plans Integration with Cornerstone.

Link Items tab

• Only items maintaining QOH can be linked.
• Linked items do not appear on the client invoice. Sales revenue is reported on the billed item only.
• Taxes are only applied to the item that is on the invoice. The tax from linked items is not applied.
• Linked quantity to deplete will calculate based on the billed item’s invoiced quantity. For example, A Lyte 4 clip is linked to an in-house electrolytes panel at a qty of 1. When a patient is billed for 2 electrolyte panels, 2 Lyte 4 clips are depleted.

Special Actions tab

• To make sure that the status of patients who are invoiced for items with the special action Mark As Deceased are truly changed to Deceased, Select Automatically mark patient as deceased in Invoice defaults under Controls > Defaults > Practice and Workstation > Invoice.

Travel tab

• Travel sheets are managed under Lists > Travel Sheets.

Whiteboard tab

• Set values for order fields to < blank> to require staff to enter details at the time of creating patient orders.
• When fields that are set to < blank> and are required to place or save orders, users can enter or select a value for the field without Whiteboard Orders Override security permission.

Related reports

• Invoice Item Setup Information Report
• Invoice Item Information Report
• Invoice Item Reminder Information Report
• Invoice Item Tax Setup Report
• Inventory Linked Items Report
• Prescription Instruction Report
• Departing Instructions Report