Authorizations

Information about Authorizations

Billing / Authorizations “Authorization expired or not valid for service date”

This is most likely due to the fact that the appointment date is past the authorization end date that this appointment was originally coded with. You may encounter this in cases where a recurring appointment series was accidentally set up past the authorization’s end date. Another explanation could be that the appointment series was scheduled to end on the same date as the authorization end date, but the authorization end date was later shortened.

Billing / Authorizations Assign a Task from the Authorization Report

Let’s say that you are looking at authorizations set to expire within 30 days and want to task a billing admin to obtain a new one. If you would like to assign a task from the Authorizations report:

  1. Navigate to Billing  and select Authorizations.
  2. Click the checkbox next to each of the authorizations you would like to create a task for.
  3. Click the Actions  dropdown at the top left of the page and select Add Tasks.

You can then create a task the same way you would from the Tasks module.

Once created, you will see a number under the tasks column , indicating the number of tasks attached to this authorization. You can also click on that number to view more details.

Billing / Authorizations Authorization Report Showing Extra Time In The “Pending” Column

CentralReach’s Authorization report is a great way of tracking approved, worked, and unused clinical hours. It will show you when hours have expired and when you are reaching the end of your bucket of authorized hours. Additionally, you may sometimes see hours in the pending column when there are no scheduled hours.

If you’re seeing additional unused time in the Pending column, please check that all appointments have been converted using the full amount of time scheduled. For example, if an appointment is scheduled for two hours, but the converted timesheet is only for one hour, the authorization report will show the unused hour as pending.

To remove this pending time from the report you can change the duration of the appointment to match the timesheet or vice versa.

Billing / Authorizations Bulk Update Authorization Settings

To save time, you can update certain authorization settings in bulk. To do so:

  1. Navigate to Billing  and select Authorizations.
  2. Click the checkbox next to any of the code groups you wish to update.
  3. Click the Actions  dropdown and select Bulk Update.
  4. From the General tab you can update the Validation & CalculationAuthorization NumberUse Service Location, and add or update your note.
  5. From the Contacts tab you can update the ManagerBillingReferringProvider/SupplierFacility, and Locked for Provider fields.
  6. When you’re done making changes, click Update Selected Authorizations.

Billing / Authorizations Create a Saved Filter

Once you’ve applied the filters you want to save:

  1. Click the Save this view as a filter link at the top of the page.
  2. Choose New filter if you want to create a new filter, or select an existing filter to overwrite it.
  3. Enter a name for the filter.
  4. Select the checkbox  next to Allow others in your organization to subscribe to this filter if you want other employees to be able to add the same filter to their account.

When saved, you will see your saved filter on the left side of the page under Recommended Filters.

Billing / Authorizations Finding Expired or Soon to Be Expired Authorizations

You can review expired or soon to be expired authorizations from the Authorizations report. This is a great tool for tracking and staying on top of your authorizations to ensure that your cash flow is not interrupted. To audit authorizations soon to be expired:

  1. Navigate to Billing  and select Authorizations.
  2. Click on the header of the Until  column and choose a date range.

You can use this audit to see authorizations that have already expired or that will be expiring within a certain date range.

You can also assign tasks from this screen.

 

Billing / Authorizations How do I use the authorizations report?

The Authorizations module will show you how many hours have been authorized, what has been scheduled, and what has been worked. This module will help you review your authorizations and understand how well your employees are utilizing the available hours within authorizations. It also helps ensure that your clients are receiving the prescribed services for them, and that services are being provided in the most efficient way to maximize your revenue. It will help maximize billing, while also highlighting services that are not authorized to prevent provision of services that would not be reimbursed.

To navigate to this module go to your $ sign icon and then Authorizations.

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From this screen, you can select which month you want to report in, and apply any filters to customize your search.

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Below is a breakdown and description of the columns on the authorization report.

Code(s): The service codes that are authorized for the client.

Valid dates: The start and end dates of the authorization. This report will only pull the authorizations that are active within your selected date range.

Payor: This lists the insurance companies linked to the authorization. If you click on the blue lines, this will pull up a list of the different insurance companies to sort by.

Manager: If a manager was listed on the authorization set up. You can also search by this field at the top to see only the authorizations under a specific manager.

Locked for: If the authorization was locked down to a specific provider. This field lists service codes where you have chosen only one provider that can use the authorized code for the client. You can also search by this field at the top to see only the authorizations locked to a specific provide.

Frequency: Indicates whether you are looking at a weekly, monthly authorization.

Authorized: This column indicates the number of hours/units/visits allowed per month.

Worked: This is the number of hours worked under the authorization.

Pending: Number of hours not yet converted on the schedule.

Remaining: How many hours are still available to be scheduled/worked on the authorization for the month.

Utilization: The percentage of the authorization that has been utilized for the month. Goal is to get this to 100% to ensure maximum utilization.

Columns those that are blue, or have blue lines next to them, allow you to open up filtering options to further drill down on your authorization report.

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This page defaults to monthly actual (not pro-rated) authorizations with hour amounts, but you can select All time to see the entire authorization period amounts, and choose to look at units or visits.

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Clicking on Filters allows you to further drill down the specific items within the authorizations. For example, you can filter by specific authorization numbers from the Authorization # field.

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The report can be downloaded into excel for pivoting/charting purposes, by clicking on the cloud icon at the top right.

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Last Updated: 3/30/2017

Billing / Authorizations How do I use the authorizations section of billing?

The Authorization tab within the billing module will provide a quick reference to authorization totals, similar to our Authorization reports that we have available.

 

Then click on the “Filters” button to filter the authorizations’ information.

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In the filters box you can filer by any billing label, client name, provider name, service code, payor, or contact label. You can add additional filters as necessary by typing the filer into the search box. Your Search will list information by client name.

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In the search box you can filer by any billing label, client name, provider name, service code, payor, or contact label. You can add additional filters as necessary by typing the filter into the search box. Your Search will list information by client name.

The search will pull client name, service code(s) authorized, Authorization type (Open if no Provider is listed: Provider if the authorization is limited to a specific provider), Valid dates of the authorization, Hours Authorized, and Units Authorized. If a manager or provider is listed in the authorization, their name will populate in the appropriate box.

Lastly, “Validation and Overbilling” tab will give you the option to Enable/Disable overbilling settings by Frequency or Total

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Billing / Authorizations Monthly (Pro-rated) and Monthly (Actual Values)

In the Authorizations report, you can view the pro-rated total and the actual totals .

  • Pro-Rated: The system calculates the authorized amounts for you. As such, if the authorized weekly amount is set as 10 hours, the system will divide the hours by 7 to calculate the daily amount and then multiply that amount by the number of days within a month, thereby giving you the pro-rated total authorized amount in a single month.

(# of weekly amount / 7 days) x (# of days in a month) =  Monthly (Pro-Rated) amount

Example: (10 weekly hours) / 7 days) x (30 days in a month) = 42.86 hrs of pro-rated monthly authorized hours

  • Actual Values: The system calculates the authorized amount by the weekly basis. As such, if there are 30 days in a single month, with 28 days being counted as 4 weeks, the last 2 days will be calculated as another whole week, thereby causing the calculation of the authorized amount to be resulted in 5 weeks. This will cause the weekly amount of 10 hours to result in 50 hours.

(# of weekly amount) x (# of weeks in a month) = Monthly (Actual Values) amount

Example: (10 weekly hours) x (5 weeks in a month) = 50 hours of monthly actual values amount

Billing / Authorizations Verify an Authorization

Once you’ve verified that the details of an authorization are correct, we recommend you use the verification feature. By verifying an authorization you are stating that all of the information within the auth is correct. This adds an additional level of accountability and ownership over your authorizations and will help minimize mistakes. To verify an authorization:

  1. Navigate to Files .
  2. Open the authorization you wish to verify and click on the Authorizations tab.
  3. Check the details of the authorization to ensure they are correct.
  4. Within the Global Authorization Settings section, click the Verify Now button.
  5. Add an optional note and click Verify.

If you clicked this button by accident, you can use the Remove button to un-verify the authorization. A record of both actions will be kept in the authorization history.

Billing / Authorizations Why is a deleted authorization still showing up on my authorization report?

If you are still able to see a deleted authorization file in your Authorization report, this is most likely due to the fact that the codes within that authorization are either still attached to appointments (indicated by the Pending column ) or timesheets (indicated by the Worked column ). Clicking on these hyperlinks will take you to the corresponding appointments and billing entries, respectively. You will also see the text Deleted next to the authorization name to display its status.