Progress Notes - ToDo Notification for the split services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Admission (Outpatient)
- App Dashboard
- Client Charge Input
- Client Ledger
- CPT Code Definition (PM)
- Delete/Re-Assign To Do Items
- Dynamic Form - Admission - Client
- Dynamic Form - Edit Service Information - Select Service(s) to Edit
- Financial Eligibility
- Guarantors/Payors
- Managed Care Authorizations
- Registry Settings (PM)
- Service Codes
- Set System Defaults (CWS)
- User Definition
- Dynamic Form - document routing - sign
- Dynamic Form - document routing - verify password
- Dynamic Form - Progress Notes
- Review To Do Item (PM)
Scenario 1: Split service - Validating 'ToDo's’ note notification requirement - Service created in 'Client Charge Input' and updated in 'Edit Service Information'.
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit, or a new guarantor is identified. Note the guarantor’s code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission (Outpatient):
- A new client is admitted in an outpatient program. Note the client's id/name, admission program,
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- A 'Managed Care Authorization' record is created for the client/guarantor/service code identified above.
- The 'Maximum Units' field is set to a value that will not cover all services. Note the value.
- Enter desired value in all required fields.
- Client Charge Input:
- A new service is rendered to the client. The 'Service Duration' is set to desired minutes that makes the number of units more than the 'Maximum Units' in the 'Managed Care Authorization' section. This will create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service, and guarantor. Note the interim billing batch#.
Steps
- Open the 'Edit Service Information' form.
- Select the service created in 'Setup' that uses the allowable un.
- Enter a diagnosis code or a referring practitioner.
- Click [Submit].
- Verify the system generates two To-dos notifications for the service updated through 'Edit Service Information' and the note is not attached to the service:
- Note requirement To-do.
- Service modified To-do. (i.e. 2022-05-11 Wednesday 02:43 PM [CLIENTFIRSTNAME CLIENTLASTNAME (CLIENTID)] Service [SERVICE CODE VALUE] For Service Date [DATE OF THE SERVICE]) Episode 1 Requires a note, 2022-05-11 Wednesday 02:43 PM Edit Service Information [CLIENTFIRSTNAME CLIENTLASTNAME (CLIENTID)] has a service '[SERVICE CODE VALUE] (SERVICE CODE)' on '[DATE OF THE SERVICE]' that was modified.)
Scenario 2: Split service - Validating 'ToDo's' note notification requirement - Service created through progress notes.
Specific Setup:
- Guarantor/Payors:
- An existing guarantor is selected to edit or a new guarantor is identified. Note the guarantor's code/name.
- Authorization Information Section:
- Select 'Check For Available Units' in the 'Verify Services and Appointments Against Available Authorizations' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Client Charge Input' field.
- Select 'Warn User If Authorization Is Missing' in the 'Verification Level For Authorizations For Appointment Scheduling' field.
- Select 'Report As Error And Include On Bill' in the 'Verification Level For Authorizations For 837 Electronic Billing' field.
- Set the 'Split Service If The Authorization Does Not Cover Units' to "Yes".
- Admission (Outpatient):
- A new client is admitted in an outpatient program. Note the client's id/name, admission program.
- Financial Eligibility:
- The guarantor identified above is assigned to the client.
- Diagnosis:
- A new diagnosis record is created for the client.
- Service Codes:
- A new service code is added as below. Note the service code/value.
- Type Of Fee= User Defined
- Minutes per Unit = desired value
- Service Fee/Cross Reference Maintenance:
- Service fee definition is created for the above service code.
- Managed Care Authorizations:
- Create a 'Managed Care Authorization' record for the client/guarantor/service code identified above. Note the client/guarantor/service code.
- The 'Maximum Units' field is set to a value that will not cover all services. Note the value.
- Enter desired value in all required fields.
- Progress Note:
- A new service is rendered to the client. The 'Service Duration' is set to desired minutes that makes the number of units more than the 'Maximum Units' in the 'Managed Care Authorization' section. This will create a split service.
- Client Ledger:
- The rendered service is split into two services: one service with the units defined in the 'Maximum Units' field and the other service for the remaining units.
- Close Charges:
- All the charges are closed.
- An interim billing batch is created to include the client, service and guarantor. Note the interim billing batch#.
Steps
- Open the 'Edit Service Information' form.
- Select the service with the units same as 'Maximum Units' defined in the 'Managed Care Authorization' form.
- Enter a diagnosis code or a referring practitioner.
- Click [Submit].
- Verify the system does not generate a progress note requirement To-do notification for the service updated through 'Edit Service Information' as the note is already attached to the service.
- System only generates the To do notification for the service updated (i.e. 2022-05-11 Wednesday 02:43 PM Edit Service Information [CLIENTFIRSTNAME CLIENTLASTNAME (CLIENTID)] has a service '[SERVICE CODE VALUE] (SERVICE CODE)' on '[DATE OF THE SERVICE]' that was modified.)
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Topics
• Client Charge Input
• NX
• Progress Notes
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