Authorization Schedule Settings

Enterprise Edition provides both homecare and hospice agencies with the ability to track insurance authorizations as dictated by a patient’s insurance coverage settings in Master Files | Payors/Plans | Plans. The Authorization component of Enterprise Edition is designed to focus on the scheduling aspect of the agency.

For example, an agency may want to enter the Authorization from the payor while still expecting physicians' order frequencies to determine when visits are scheduled. In this case, the physician's order frequency determines the schedule and the corresponding Authorization will enable prompts and constraints in order to ensure the clinician maintains compliance with the insurance authorization. In another example, an agency may want the Authorization to determine when visits are scheduled for a patient. In this case, clinicians will be able to enter narrative orders that do not contain a physician order frequency (as the Authorization will be used to populate the Schedule).

The most appropriate setting for each payer is determined by each agency, which will include one of the following scenarios:

The Schedule from Auth option should be used by agencies that will only perform visits for the number of authorizations that have been approved by locking down scheduling from authorizations. This option allows the user to create visits in scheduling from the Authorizations tab. This function works for all types of authorization frequencies except for Flat (Flat frequencies are not included in this option because the definition is a “flat” set of visits for a discipline which does not have any scheduling logic for the number of visits per week or days that are best for visits). Text orders can still be entered for tracking any necessary verbal orders from physicians. However, visit frequencies for any of those verbal orders would determined using the corresponding authorization.

When this option is selected the user will not see the Schedule shading from Authorizations because the authorization defines the calendar, but can generate visits in the Schedule.

An additional option is available for agencies that wish to track Authorizations while continuing to schedule visits from order frequencies. Additionally, if your agency requires an open authorization to create documentation then agencies can utilize the Require open authorization to create documentation checkbox. This option is only available when the Scheduling from Auth setting is NOT selected.

This option takes compliance to the Authorization a few steps deeper than option 2, No Authorization Setting Selected. This option will continue to prompt clinicians while creating order frequencies that exceed the Authorization, like Option 2; however, it will not allow a clinician to lock/sign a visit note or assessment if the visit date does not fall within the Authorization. Without locking/signing the note, the charge and/or payroll record for the visit will not flow forward. With alerts activated the clinician will also be reminded upon each login that documents remain unlocked/unsigned. This option forces the clinic user to then contact the back office to obtain Authorization for those visits. Upon obtaining Authorization, the system will then allow the lock/sign function for the clinician. If Authorization is not obtained, or is rejected, the clinician would then delete the P Page and lock/sign their document without the P Page record, thus blocking the billing/payroll record for an unauthorized visit from going through.

When the Require open authorization to create documentation option is selected the user will see the Schedule shading from Authorizations and Patient Schedule, showing the clinician immediately when they are writing order frequencies that exceed Authorizations. If more than one discipline has approved Authorizations, the Auth Discipline must be selected from the drop-down menu in Patient Schedule to view different discipline shading.

Agencies that want to track Authorizations, but don’t want to put Authorization parameters around how many visits are available for a patient, should not select an Authorization setting checkbox in Master Files | Payors/Plans. If no Authorization setting checkbox is selected and the user enters an order greater than the Authorization, the user will receive a message stating “out of authorization” (See Exceeding Authorized Visits for more information).

When no Authorization option is selected the user will see the Schedule shading from Authorizations to guide the clinician on the Authorization period as it relates to the order frequencies being written.

Authorization Settings Chart

	Both Unchecked	Only Schedule From Auth is checked	Only Require open authorization to create documentation is checked
Able to schedule from Authorizations	No	Yes	No
Shading appears in Authorization Calendar	Yes in all except Flat frequency authorizations. Flat will have a label.	No	Yes on all except Flat frequency authorizations. Flat will have a label.
Shading appears in Patient Schedule	Yes	No	Yes. User must select the discipline in the Auth Discipline to see shading.
Shading appears in Order Calendar	No	No	Yes
Able to enter Orders for Visits	Yes	Yes but HCF recommends to use orders for only verbal orders and not visit frequencies since the authorization drives the schedule population.	Yes
Lock down Generate Visits	Yes in the Authorization Calendar. No in the Patient Order Calendar.	No	Yes in the Authorization Calendar. No in the Patient Order Calendar.
Able to enter document and lock for visit over Authorization	Yes	No	No
Documents validate against Authorization	No	No	Yes
Prevents documents from being locked/signed for visits outside the Authorization	No	No	Yes