Utilize Billable Service for Authorization Allocation
This feature applies only to Agencies that have been updated/migrated to the latest versions of the Caregiver Compliance, Prebilling Optimizations, and Authorization Optimizations (Phases 1 and 2). Contact HHAeXchange Support Team for further details and/or to enable the feature.
The system calculates the Authorization units used based on Billable Service Time rather than the Scheduled Time. If the Billable Service Time is less than the Scheduled Time, then the Authorization units are returned to the Authorization. For example, the system applies 2 Authorization units for a visit that is scheduled for 2 hours. If this visit is confirmed for 1.5 hours, then the system adjusts the applied Authorization units to 1.5 and returns the remaining .5 to the Authorization.
This feature applies only to Hourly Type visits. Authorization units are rounded to the nearest 15-minute interval.
Once the feature is enabled by HHAeXchange Administration, the Allocate Visit Authorizations based on Billable Service checkbox shows as selected (read-only) in the Scheduling/Confirmation tab of the Contract Setup page under Admin > Contract Setup > Contract Search.
To enable at the Agency level, select the Recalculate Visit Authorization units based on Billing Adjustment checkbox.
Once this feature is enabled, all active Authorizations are recalculated. Once recalculated, if there are any visits from start date of active authorization that have Billable Service Time less than Scheduled Time, then the Authorization units are updated and the difference is returned to the active Authorization.
Scenarios
As mentioned above, this feature applies only to visits with an Hourly Rate Type. Adjustments apply to the Visit Confirmation Time. The scenarios below apply to Skilled and Non-Skilled visits.
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Details |
Outcome |
|---|---|
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Visit Rate Type: Hourly Schedule Time: 4 hours Confirmed Time: 2 hours |
System uses only 2 Authorized units based on the Confirmed Time; the remaining 2 units are returned to the Authorization. Billable Time is 2 hours (2 units). |
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Visit Rate Type: Hourly Schedule Time: 4 hours Confirmed Time: 5 hours |
System uses 4 Authorized units based on Scheduled time; Confirmed Time exceeds Scheduled Time. |
For the following scenarios, the Disable Visit Schedule Rounding and Disable Visit Confirmation Rounding checkboxes are selected in the Scheduling/Confirmation tab under Admin > Contract Setup.
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Details |
Outcome |
|---|---|
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Visit Rate Type: Hourly Schedule Time: 13:00-16:00 (3 hours) Confirmed Time: 13:00-14:07 (1 hour, 7 minutes) |
System uses 1 Authorization unit based on the Confirmed Time; rounded (down) to the nearest 15-minute interval. |
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Visit Rate Type: Hourly Schedule Time: 13:00-16:00 (3 hours) Confirmed Time: 13:00-14:08 (1 hour, 8 minutes) |
System uses 1.25 Authorization units based on the Confirmed Time; rounded (up) to the nearest 15-minute interval. |
The scenarios below apply to both Skilled and Non-Skilled visits. In addition to the selected Allocate Visit Authorizations based on Billable Service checkbox, the Recalculate Visit Authorization Units based on Billing Adjustment checkbox must also be selected both in the Scheduling/Confirmation tab in the Contract Setup page. Only Hourly Rate Type applies to these scenarios. For all other Rate Types, the system applies the scheduled time Authorization units.
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Details |
Outcome |
|---|---|
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Visit Rate Type: Hourly Schedule time: 4 hours Confirmed Time: No confirmed time yet Billing Adjustment: +1 |
System uses only 4+1=5 Authorized units (Schedule time +Billing Adjustment). |
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Visit Rate Type: Hourly Schedule Time: 4 hours Confirmed Time: 2 hours Billing Adjustment: -1 |
System uses 2-1=1 Authorized unit (Billable time =Confirmation time - Billing Adjustment) |
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Visit Rate Type: Hourly Schedule Time: 4 hours Confirmed Time: 2 hours Billing Adjustment: +1 |
System uses only 2+1=3 Authorized units (Billable time =Confirmation time +Billing Adjustment). |
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Visit Rate Type: Hourly Schedule Time: 4 hours Confirmed Time: 4 hours Billing Adjustment: +10 |
System uses 4+10=14 Authorized units (Confirmation time +Billing Adjustment). A validation window warns when the used Authorized units exceed the allocated Authorized units.
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