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Authorizations (article)

Summary:

Authorization is the pre-determined permission to bill a specific service to a specific payer. In PIMSY, we have taken that definition and expanded upon it.   In order to write a note, you must have an authorization (auth) to use that code on that client. This can either be a real authorization from a payer source or a placeholder auth assigned by support/admin staff. Either way, permission to document on a code (service) must be assigned.

Columns:

Billing Code – includes all the CPT, HCPCS, E/M, and CPT Add On codes listed in your system.

Start Date – first service day that this auth can be used. If a note is created with a service date prior to this start date then this auth will not be available from the bill code drop-down on the note.

End Date – last service day that this auth can be used. If a note is created with a service date after the end date, this auth will not be available from the bill code drop-down on the note. The system will inactivate this auth at the end of the day on this date.

Allotted Units – total number of units that may be used on this auth.

Remaining Units – number of units left on the auth. Once this counts down to 0, the system will inactivate the auth and cannot be used.

Pending Units - number of units used on notes that have not yet been released.  The units have been accounted for but the notes have not been released. The units are deducted when they are deducted from the Remaining Units.

Unit Alert Level – works the same as the Unit Alert Level seen elsewhere in the system. If a Unit Alert Level has been entered, the system will begin alerting staff to get a new auth once the Remaining Units reaches the Unit Alert level.

Exp. Alert Days – works the same as the Exp. Alert Days seen elsewhere in the system. If the Exp. Alert Days has been entered, the system will begin alerting staff to get a new auth once the End Date reaches the Exp. Alert Days.

Auth # – number is auto-generated by the system. However, if you receive a real auth from a payer, enter the auth # that the payer gave you into this field. This is for tracking purposes and comes in handy if you need to call the payer and refer to a specific auth.

Specific Provider – nables a specific provider to be attached to an auth in those cases where a payer limits who can provide service on the auth.

Insurance Company – enables an auth to be assigned to a specific payer on the client’s chart when the client has more than 1 payer on file. When a note is created, the system will look to the auth first to assign the primary payer for the claim. If this is empty, the system will default to the primary payer listed on the client’s chart.

Exclude from Notes – removes this auth from the billing code drop-down in the note.

Package # - This is no longer used

Auth Group – assigning a set of auths to a group enables the system to decrement those auths together, as a group, rather than individually.

Unmanaged – when checked, this tells the system not to decrement this auth. It makes the auth “unlimited” within the date range assigned.

Active – an auth will be made active according to the start and end dates, as well as the remaining units. This column is controlled by the system. Note: if an auth is inactive, but has remaining units, the auth is still available to be used if a note is created for a date that falls within the auth start and end dates.

Default – when checked, this auth will default into the billing code drop-down on the note if no billing code is chosen by the provider.

Suspend Alerts – when checked, all alerts associates with this auth will be suspended.

Sliding Scale % if a client should not pay the full price of the service charged, place their percentage charge here, and PIMSY will calculate that and show that amount to charge throughout the system.

Inpatient – when checked, this will automatically update the note to be an inpatient note.

Last Edited Date – last date the Auth was edited.

Last Edited By – person who last edited the Auth

Primary Therapist – primary therapist associated with this client and Auth.

DOB - client's date of birth.

Instructions:

BASIC AUTH GROUPS

An Auth group allows the system to decrement units from a group, rather than from the individual code. First, set up the groups by going to Administration > Pick List Management.

Select Billing in the Group Pick List, then the Auth Groups tab.

PIMSY comes with two groups to set up out of the box. You may add more if needed. You can rename these.

Make sure the groups are Active.

Click Save.

Refresh Pick List under Utilities so you can see your changes.  

Click on the Authorization tab in the client’s chart. Click on a new line and select the code out of the drop-down box. Next, enter the amount of units that has been authorized. In the next column, enter how many units are remaining (it may differ depending if the client was seen prior to the authorization being received).

Once all the codes are in, go to the column and select the Auth group you want in the drop-down box (based on what you named it). Click Save.

Now, whenever any of those codes are used, PIMSY will deduct from each of the codes in the group to ensure you do not bill over the alloted amount per the group authorization.

Example: If you are approved for 20 therapy sessions from an insurance company and it includes codes 90832, 90834, 90837, and 90853, you would add the Auth Group for each of these codes, with “20” listed for the alloted units on each billing code line. PIMSY will allow you to see the client 20 times with a combination of these codes, rather than 20 sessions for every code if you have them all attached to the same Auth Group.

What is the secret to setting up authorizations so you do not run out?

If you have 16 authorizations, enter 12. When the therapist runs out of auths they should submit a request to get new authorizations. Give them 4 units to hold them over until the new auths are approved. This way you won't run out.

Related Articles:

If you cannot find what you need in this article, please contact Support (email) or call 877.334.8512 ext. 3.

 

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