Treatment Plan/EPC visit counter

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  • Idea
  • Updated 3 years ago
  • Implemented
  • (Edited)
Medicare only allows for 5 EPC visits per calendar year. Referrals from one year can overlap into the next. 

When a patient uses a visit from the previous years referral and then obtains a new referral for 5 visits for the current year.  The visit counter does not warn the practitioner who could bulk bill for a 6th  visit, only to have payment for the 6th visit rejected.
Can we have a number of visits in the calendar year counter included into the number of visits warning. This will help prevent rejected payments.
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Trevor Thomson

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Posted 4 years ago

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Hugh Matthews Podiatry- Ballarat

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Yes we have a problem with this also.  We use 'new account' set up for each new referral, to keep track as best we can. it will keep them all separated and a quick look at the year also helps. We also keep manual notes for EPC's that are confusing.  A simpler solution would be fantastic
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Celia Young

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We would love to a visit counter for accounts.  We make a new account for each of our Acc claims (New Zealand) and each claim is entitled to a certain number of visits.  Clients are always asking how many visits they have left so we have to count up how many visits they have had.  It would be awesome to have some sort of counter so we didn't have to count up each individual transaction.  Even another box in the Transaction Plan box that shows how many visits they have had to date since the start date put into the plan would be awesome.  Is this possible?
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Steven, Business Care

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Hi Celia

Just for other users I want to recap the existing Treatment Plan functionality in Front Desk.

From the Billing Details tab on a patient’s file you can create a Treatment Plan. You can set the number of treatments (or a monetary amount allocated) and an alert at a certain value to appear after your client has been billed or on the Treatment Plan Report (Reports > Treatment Plan Report). Further, you can specify the treatment plan to only track a particular item code or schedule which can be used to track ACC claims in your example.



I think it is a good idea that we consider displaying the status of the treatment plan say 4/10 (4 of 10 treatments in) on the Billing Details tab without the need to wait for the alert to popup or to produce the report.
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Celia Young

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That would be a brilliant idea
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WOC

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that would be great, we currently manually record then in the notes to make it quicker to check when patients ask
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Joyaa Antares

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We would support a change to cover the situation Trevor outlines.  (I didn't exactly follow if your suggestion will cover this Steven, but if it does, that would be grand).
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Celia Young

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This reply was created from a merged topic originally titled Current status of treatment plan displayed in treatment plan box.

A while ago you stated that this was being considered.  Is there any update on this?  This would be an awesome idea and be a great addition to Front desk 
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Trevor Thomson

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I have not heard anything about a treatment plan counter upgrade.
The existing counter still only counts visits used per plan and does not show visits per calander year.
Only half the task, you still have to go into the transactions file and count the visits for the calendar year.
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Andrew, Community Manager

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We are definitely thinking about adding a 'general' Treatment Plan counter, that will display the number of treatments used and remaining within an individual treatment plan.

I can see a few users have expressed interest in the idea, but whether to include a counter for the calendar year is still under consideration.
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Trevor Thomson

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Andrew.
For us any change not showing the number of visits for the EPC item number taken in a calendar year gains us nothing.

We will still have to go to the transactions file and count the visits.
If it is more than 5 and we Bulk Bill we do not get paid.
It does not matter how many visits are left on a referral

We need to know if there is a valid referral and less than 5 visits have been taken for the year.
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Andrew, Community Manager

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Thanks Trevor. We do understand your suggestion and the reason behind it; your point has been noted.
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Celia Young

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Luckily we don't need a counter for a calendar year but couldn't you just change the date that the count starts from in the treatment plan to the beginning of the calendar year?  That way the count would only apply to that calendar year.
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Joyaa Antares

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As Trevor correctly wrote at the start of the thread, "referrals made one year can carry over to the next". Bearing this in mind I can't quite get my head around how a counter-for-calendar-year will meet needs? Isn't a count-for-the-plan (which is what we already have) the most important counter?
Please can someone explain this to me?
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Wendy Mallet

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This is a difficult area and we spend a lot of time counting EPC visits (5 per calendar year) and also GPMHCP referrals visits (10 per calendar year for our Psychologists). Referrals can cross over different calendar years but we can only bill 5 x EPCs /10 x GPMHCP visits per calendar year. I work at a multi-modal practice where a patient could be referred to any combination of: Podiatry, Dietician, Ex Phys, Chiropractor, Osteopath, Physio and more under an EPC referral/s.


I think we nearly need a new system for this entirely:

I could envision that on each item code we could nominate that it is an EPC item code or a GPMHCP item code with perhaps a tick box for which type of code it is (perhaps the names of these options and the number of visits could be something that could be manually configured by the practice and so may be able to be used for a range of things). Once this was done, you could then could set up a counter for the patient that tells you how many of each type of appointment was billed for a range of dates or perhaps set options something like "This Calendar Year" or "Last Calendar Year".

It would be awesome if the count could be displays if you hover over an appointment. It would probably be useful if the count was shown on the patient file as well, probably on the Appointments tab.

Further to that, if you tried to book an appointment using a code where the limit was exceeded, you would get a warning message (there may be a mistake that needs fixing so perhaps a warning at that point rather than not allowing you to book the appointment).

if you tried to bill one of the codes that means you will exceed the limit for the year, you would get a message displayed and would not be allowed to bill the code.

This would save a huge amount of time for our practice.
(Edited)
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Neil Dembo

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All great, problem occurs, where you have a valid EPC, however the Doctors have not understood how an EPC works, and gives for example 3 to a physio and 3 to a Dietitian. the 6th billing is going to be rejected. Or the patient has already seen someone X times in the early part of the year, the GP gives them a new EPC, however low and behold, when this is billed ( the 6th visit) , it will reject. patient swears blind, they have seen NO ONE else this year. So while your counters are all a great idea, where you are the only referee, there is still the inherent issue with the way the EPC work that may cause rejections
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Anna & Val

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To explain how an EPC or GPMHCP can cover 5 or 10 appointments per year and also be allowed to carry over into the next year, this is because each referral covers 5 or 10 appointments (depending on if it's an EPC or GPMHCP) but can be given at any time of the year. Each referral is valid for 12 months. If a client gets a referral in November/December and only uses 2 of those appointments before the end of the calendar year, those remaining 3 or 8 appointments can be used in the next calendar year. However, if that same client uses those appointments early in the next year and then gets a new referral later the same year, they can only use 2 appointments as that will take them to their calendar year limit.

In our Psychology practice we mostly do GPMHCPs & no longer use the treatment plan as we found it easier to add our own manual tracking into our transaction description. eg 80110 Treatment Consultation 2/5 (2/10). The first number is how many visits the client has used from that referral. The second is how many visits they have used that calendar year. In January we start again at 1/10 for every client under a plan, and we check the previous transaction before taking the payment so that we keep the count correct. This stops the confusion of accidentally counting visits done privately, or for any other reason, that aren't covered under the plan.

We also add a new billing for each new type of referral we get, especially ATAPS which each have a different claim number and 6 visits.

I'm not sure what the fix is but it would be good to see a referral counter and a calendar year counter on each billing tab so that you could easily see for that client where that referral was up to. And/or to be able to hover over the appointment to see those details. A warning on booking would also be good so that you didn't book a bulk bill appointment that couldn't be bulk billed.
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Timothy, Business Care Manager

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Hi all. From listening to your feedback, we're happy to announce some enhancements to treatment plans in Front Desk 16.9.3. Please see the following post for more information: https://community.smartsoft.com.au/smartsoft/topics/new-enhancements-to-treatment-plans
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Karen

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Thank you! This is just what we needed. Will this enhancement be included in the next Web Appointment Book upgrade?
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Steven, Business Care

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Hi Karen

I can confirm that this feature will be integrated with the Web Appointment Book in a future release
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Trevor Thomson

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Hi Tim,
I have just updated to 16.9.3.
we use three item numbers for EPC plans. ( podiatry)
10962      for a new patients first visit
10962C   for continuing visits
10962H   for home visits.
In our practice each type of 10962 attracts a different fee. 
Frontdesk handles or converts the item numbers before sending to Medicare but not so with the yearly visit counter.

The EPC per year counter only counts/tracks one of the above three item numbers.
  PS. 
Thanks to Gerry and the team for their good work so far
(Edited)
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Steven, Business Care

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Hi Trevor

To track multiple item codes in a treatment plan you can use Item Code Schedules. Ensure that your Medicare items or all services (excluding products) are in one Schedule and set up a treatment plan with that schedule. Then only these billed items will be included in the count.
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Trevor Thomson

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Thanks  Steve,