Define Visit Limit Parameter dialog
Path: Patient > General > Authorizations > Authorization Date > Define Visit Limit Parameter
Path: Patient > General > Patient Limits > Define Visit Limit Parameter
With the Define Visit Limit Parameter dialog, you can set up payer coverage limits for the disciplines, roles, and levels of care.
There are two tabs on the Define Visit Limit Parameter dialog: Authorized and Requested. The Authorized tab is enabled and displays the information in the Parameter field of the Authorization Date view if there is an authorization number indicated. The Requested tab is active and displays the information in the Parameter field if the Pending check box is selected.
With parameters, you can define authorization. An example of a parameter is "3 visits per week for 3 weeks for a total of 9 visits". This enables the system to track the number of visits scheduled based on the parameters defined. For example, using the definition above, if a parameter is not defined and the number of visits authorized is simply indicated as nine, the system will not prevent 9 visits from being entered 9 days successively. With the parameter defined as stated, the system warns you if a fourth visit is scheduled in a given week.
Limits may be set as the number of visits, dollar amount authorized, number of hours authorized, or number of units authorized for Discipline and Role. Limits for LOC can be defined by days and dollars. You may also set the frequency that will apply for the defined limits, and the period within which those limits and frequencies are valid.
| Field | Description |
|---|---|
|
Services |
To enter a services limit for a discipline, role, and LOC, specify the number of visits, hours, dollar amount, or units allowed. To enter a service limit for LOC, specify the number of days or amount. |
|
Limit Type |
To define the limit type of the number selected in the Services field, select the needed type from the drop- down list. Available selection options vary based on the type of authorization being defined. Discipline and Role options include visits, hours, dollars, or units allowed. The LOC options include days and dollar amount. |
|
Frequency |
To define the frequency for a defined discipline, role, or LOC, select it from the drop-down list. Available options include Per AM, Per PM, Per Day, Per Week, Per Month, Per Certification Period, Per Year, or Pattern. The selection of Pattern enables you to indicate how many of the services can be delivered over a period. For example, a pattern may be that a patient can receive one visit every three days for four weeks, not to exceed a total of nine visits. |
|
Per Every Number Of |
Enabled only if Pattern is selected in the Frequency field. Pattern enables you to define a custom frequency condition for a selected discipline, role, or LOC. To enter a number of days, weeks, or months for the frequency condition, enter the number allowed. |
|
Time Limit |
This field is enabled if Pattern is selected in the Frequency field. Define the period for which the Per Every field is defined. For example, "every 3 days". "Three" would be entered in the Per Every field and "days" would be entered in this Time Limit field. You can select days, weeks, or months. |
|
Duration |
To define the period for the authorization limit, under For enter the number to be associated with of days, weeks, or months allowed. |
|
Duration Type |
To define the duration type that applies to the Duration field, click and select the type. |
|
Limits |
To define the limits for the services selected in Services field, enter the total number of visits, hours, dollars, units, or days allowed. To define the limit type for the number selected, make your selection from the list. |
|
Week Type |
To define the week type, select one of the following check boxes:
|
|
Week Start |
To define the start day of the week, select one of the check boxes. |
|
Defined |
This field shows the result of the parameters defined in the Define Visit Limit Parameters dialog. |
Associated pages
- About Authorizations
- About single authorization
- About multiple authorizations
- About Authorizations window
- Authorizations window fields
- Authorizations window – Authorization Date view
- Authorizations window – Discipline tab
- Authorizations window – Role tab
- Authorizations window – LOC tab
- Authorizations window – Supply tab
- Authorizations window – Supply Group tab
- Authorizations window – Authorization Number view
- Authorizations window – Authorized Care view
- Set up privileges for authorization
- Recommended setup for authorizations
- Enter insurance authorization information for patients
- Allow authorizations for contractor resources
- Authorizations - how Homecare links services
- Generate separate claims per authorization