Multiple billing code treatment plan

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I would like to be able to create multiple treatment plan alerts for a patient who has been approved for different services eg 4 x treatment and 16 x Pilates classes and 3 x massage. These have different billing codes so cannot be on the same treatment plan making it difficult to keep track of exactly where they are up to before needing further approval.
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Rachel Bruce

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Posted 3 years ago

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Steven, Business Care

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Hi Rachel

Being able to manage multiple treatment plans concurrently can be accomplished by using a different account for each treatment plan required. This is typically used when multiple WorkCover or MVA claims occurring at the same time.



We haven’t come across a case that requires this level of specificity in a treatment plan as you can currently highlight individual item codes, a schedule of item codes or a group of handpicked item codes. Further, a treatment plan can be based on total value such as $1,000.

My suggestion is probably not workable if you need to track 3 separate groups of items each occurring a different number of times in one account.
(Edited)
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Rachel Bruce

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Hi Steven, thanks for that. We currently use multiple accounts for different services or like your example of Primary, Workcover etc. Unfortunately I'm looking for a solution for multiple items on the one account. Perhaps this could be something to consider for future updates? Thanks again, Rachel
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Hari Conidaris

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When a treatment plan is very close to finishing, we may pre-approve the next treatment plan.  There is no way for this to be pre-loaded in the system, as it is the same account and same item number. And I am reluctant to simply 'adjust' the existing treatment plan. If you were contemplating multiple treatment plans at any stage, logging a complete treatment plan history could enable you to include the concept of entering the 'next' treatment plan before the current treatment plan was finished, with the same item number and account. It would also facilitate improved reporting on treatment plans.   
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Steven, Business Care

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Hi Linda
Treatment Plans basically keep track of the number of treatments (or a dollar amount) that have been approved for a patient’s care by a third party payer such as an insurance company. If you have 2 treatments left in an approval and you are approved for another 10, you would simply adjust the treatment plan to show you have 12 treatments left in the treatment plan.

If it is important for you to store the details of treatment plan approvals, I would suggest that you set up an Event type called “Treatment Plan Approval”. Every time you have an approval you could add this event with the details of the approval, which can also be reported on if need be. Further if you want to keep a copy of the original documentation it can be added as an attachment against the patient file.
(Edited)
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Rachel Bruce

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Hi Steven, just wondering if there has been any further thought to this idea please?

We have multiple patients who have treatment plans which include various numbers of physio, hydro, exercise physiology and Pilates session all on the one plan which can get pretty messy especially when trying to keep up with which item approval limits have been reached and which are still going when the next treatment plan is approved.

Thanks
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Steven, Business Care

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Hi Rachel

I'm note sure there is much more I can add. Each patient can have multiple treatment plans running if you use a separate account for each treatment plan (as described earlier in the post). You need to have an item code group set up with all the item codes that need to be included in the plan. Further, you need to bill to this account with one of the item codes included in the item code group to be counted as a treatment in the treatment plan for this account. This supports multiple treatment plans with multiple practitioners running concurrently with other treatment plans.

From what I can see in this post the bit you might be missing is setting up an item code group to be used in the treatment plan. This will include all the different billed items, by all the different practitioners as required. The treatment plan can either be set to use number of consults or total $ value approved.

It requires some discipline to make sure this works correctly, as you say you're trying to manage a complex situation.

If you are looking for something else, specifically what do you suggest to make this better?
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Rachel Bruce

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Hi Steven,

What I'm looking for is to be able to enter the number of each individual item code approved
eg

starting date of 27/7/2016

pt210 x 6 (alert after 4)
pt460 x 20 (alert after 16)
ep103 x 14 (alert after 10)

If we could enter the code and the number approved, each as a separate item on the treatment plan, we would have a simple way to keep track of the patient's usage for everything approved.
At present we have to decide which one of the codes we will enter into the treatment plan and then remember to manually keep a track of the other approved items.

If in this case, the patient uses up most of their pt210's well before the pt460 or ep103's a new treatment plan would need to be submitted and approvals may overlap making it difficult to keep track of where the pt460's or ep103's are up to in relation to both the initial and new approvals.

Generally speaking, the case managers that we deal with approve numbers of treatments rather than set a dollar limit so making a group with a limit (totalled using all relevant codes) is not a viable option for us
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Steven, Business Care

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Typically we do not see these types of approvals for treatment given. The way to do this is to set up a different account for each group of treatment approvals provided, with a description in the account for each set of treatments. 

Is there anyone else in the Community that gets approvals such as those detailed above?

starting date of 27/7/2016

pt210 x 6 (alert after 4)
pt460 x 20 (alert after 16)
ep103 x 14 (alert after 10)