Patient Limits

Patient Limits Window – Discipline Tab

Enter specific patient limits information based on discipline code on the Discipline tab.

>	Effective Date – Specify the effective date for this discipline limit.

>	Expiration Date – Specify the expiration date for this discipline limit.

>	Discipline Code – Select the discipline code for the patient limit.

The selection options available are defined in Administration>Clinical>Disciplines.

>	Description – This field shows a description for the selected discipline code.

Descriptions of the discipline are defined in Administration>Clinical>Disciplines.

>	Procedure Code – This field shows a procedure code used for this discipline.

Procedure codes are defined in Administration > Financial> Insurance Codes

>	Code – Select the type of service you have received authorizations for. Service codes available for selection are Staff Service Codes defined in Administration > General > Service Codes / Staff.

Note: This is optional information in the authorization. A common reason for defining a service code is if a payer has granted one authorization for an initial assessment visit and will grant additional visits after that visit is completed. Another scenario may include a difference in your usual and customary rate for a routine versus an initial visit.

>	P (Define Parameter) – To define visit limit parameters, click to open the Define Visit Limit Parameter window.

>

Parameter – This field shows a description of the parameters defined in the Define Visit Limit Parameter window. Parameters enable users to define payer limit information. 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/entered based on the parameters defined. For example, using the definition above, if a parameter is not defined and the number of visits approved 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 will warn users if a fourth visit is scheduled in a given week.

>

Include Non-Billable Services – This setting controls whether non-billable services should be counted towards the authorized visit limits. For example, the payer authorized three visits for the month. To date you have made two billable visits in addition to one non-billable service. If this option is set to Yes (either by default of the payer or selected manually) the system will count the non-billable visit towards the number of visits made. If this option is set to No (either by default of the payer or selected manually) the system will not count the non-billable visit towards the authorized visit limit.

The default option will be populated based on the setting defined for the payer in Administration>Financial>Insurance Codes. Select from the following:

•

Yes

•

No

•	Default from Insurance

Patient Limits Window – Role Tab

Enter specific patient limits information based on resource type role on the Role tab.

>	Effective Date – Specify the effective date for the role limit.

>	Expiration Date – Specify the expiration date for the role limit.

>	Role – Select the role for the patient limit.

The selection options available are defined in Administration>General>Resource Types.

>	Description – This field shows a description for the selected resource type.

>	Code – Select the type of service you have received authorizations for. Service Codes available for selection are Staff Service Codes. These codes are defined in Administration>General>Service Codes/Staff.

Note: This is optional information in the authorization. A common reason for defining a service code is if a payer has granted one authorization for an initial assessment visit and will grant additional visits after that visit is completed. Another scenario may include a difference in your usual and customary rate for a routine versus an initial visit.

>	P (Define Parameter) – To define visit limit parameters, click to open the Define Visit Limit Parameter window.

>

Parameter – This field shows a description of the parameters defined in the Define Visit Limit Parameter window. Parameters enable users to define payer limit information. 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/entered based on the parameters defined. For example, using the definition above, if a parameter is not defined and the number of visits approved 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 will warn users if a fourth visit is scheduled in a given week.

>

Include Non-Billable Services – This setting controls whether non-billable services should be counted towards the authorized visit limits. For example, the payer authorized three visits for the month. To date you have made two billable visits in addition to one non-billable service. If this option is set to Yes (either by default of the payer or selected manually) the system will count the non-billable visit towards the number of visits made. If this option is set to No (either by default of the payer or selected manually) the system will not count the non-billable visit towards the authorized visit limit.
Select from the following:

•

Yes

•

No

•	Default from Insurance

Patient Limits Window – LOC Tab

Enter specific patient limits information based on level of care code on the LOC tab.

>	Effective Date – Specify the effective date for the level of care.

>	Expiration Date – Specify the expiration date for the level of care.

>	LOC (Level of Care) – Select the level of care code for the patient limit.

The selection options available are defined in Administration>General>Patient Acuity Levels.

>	Description – This field shows a description for the selected level of care code.

>	Disc (Discipline Code) – Select the discipline code for the patient limit.

The selection options available are defined in Administration>Clinical>Disciplines.

>	Description –This field shows a description for the Discipline code selected.

Descriptions of the Discipline are defined in Administration>Clinical>Disciplines.

>	Code – Select the type of service you have received authorizations for. Service Codes available for selection are Staff Service Codes. These codes are defined in Administration>General>Service Codes/Staff.

Note: This is optional information in the authorization. A common reason for defining a service code is if a payer has granted one authorization for an initial assessment visit and will grant additional visits after that visit is completed. Another scenario may include a difference in your usual and customary rate for a routine versus an initial visit.

>	P (Define Parameter) – To define visit limit parameters, click to open the Define Visit Limit Parameter window.

>

Parameter – This field shows a description of the parameters defined in the Define Visit Limit Parameter window. Parameters enable users to define payer limitations. An example of a parameter is "3 continuous care days per month for 3 months for a total of 9 continuous care days". This enables the system to track the number of days based on the parameters defined. For example, using the definition above, if a parameter is not defined and the number of days approved is simply indicated as nine the system will not warn on the tenth continuous care day.

>	Include Non-Billable Services –This setting controls whether non-billable services should be counted towards the authorized visit limits. Define whether the Non-Billable Services provided should be included into report. Select from the following:

•

Yes

•

No

•	Default from Insurance

Patient Limits Window – Supply Tab

Enter specific patient limits information based on the supply code on the Supply tab.

>	Effective Date – Specify the effective date for this discipline limit.

>	Expiration Date – Specify the expiration date for this discipline limit.

>	Supply – This setting controls whether non-billable services should be counted towards the patient limits. Select the supply code for which you want to define the patient limit.

The selection options available are defined in Administration>General>Supplies.

>	Description – This field shows a description for the selected supply code.

>	Quantity – To enter a quantity limit for the selected Supply, enter the number of the quantity allowed, or click the down arrow until the correct number appears.

>	Dollars – To enter a dollar amount limit for the selected supply, enter the amount allowed, or click the down arrow until the correct number appears. The dollar limit defined is the maximum billable dollar amount for the entire length of the authorization.

>	Include Non-Billable Services –Define whether the Non-Billable Services provided should be included into report. Select from the following:

•

Yes

•

No

•	Default from Insurance

Patient Limits Window – Supply Group Tab

Enter specific patient limits information based on the supply group code on the Supply Group tab.

>	Effective Date – Specify the effective date for this discipline limit.

>	Expiration Date – Specify the expiration date for this discipline limit.

>	Supply Group – Select the supply group code for which you are receiving authorizations.

The selection options available are defined in Administration>General>Supply Groups.

>	Description – This field shows a description for the selected supply code.

>	Quantity – To enter a quantity limit for the selected Supply, enter the number of the quantity allowed, or click the down arrow until the correct number appears.

>	Dollars – To enter a dollar amount limit for the Supply Group selected, enter the mount allowed, or click the down arrow until the correct number appears. The dollar limit defined is the maximum billable dollar amount for the entire length of the authorization.

>	Include Non-Billable Services – This setting controls whether non-billable supplies should be counted towards the patient limits. Define whether the Non-Billable Services provided should be included into report. Select from the following:

•

Yes

•

No

•	Default from Insurance

Entering Patient Limits

1.	In the Patient component, select a patient.

2.	Go to General>Patient Limits.

3.	Click the required tab (Discipline, Role, LOC, Supply, or Supply Group).

4.	Complete the fields as appropriate.

5.	Save your changes.

About Patient Limits

Patient Limits Window – Discipline Tab

Patient Limits Window – Role Tab

Patient Limits Window – LOC Tab

Patient Limits Window – Supply Tab

Patient Limits Window – Supply Group Tab

Entering Patient Limits