All Notes: How to Approve Notes
This section provides an overview of the workflow for approving notes in OnTarget Clinical.
The approval process is a very important function for every note type. The supervisor’s approval of the note carries three main responsibilities. First, it is the mechanism for putting the supervisor’s signature on the note. Second, it allows the note to be pulled into billing. Last, it allows the note to be pulled into the timesheet for payroll. It is important to note that all three of these functions are optional.
Every note is assigned to a supervisor, and it is this person who is responsible for approving the note. The only person other than the supervisor who can approve the note is a Super User. The supervisor’s name auto-populates to the note based on the assignment at the client’s screen.
System administrators can control the names that display in the client supervisor list so that only staff members with appropriate credentials are eligible for selection. This prevents someone without supervisor capabilities from being able to sign off and approve a note. That control is managed through job titles (List Configuration–>Employees–>Job Titles) . Job titles associated with employees who will approve notes should be determined. Those job titles are then marked as supervisor/approver.
The job title with supervisor/approver capability is then assigned to the employee under the Employees section on the Demographics tab. Once the job title is assigned to the employee, that employee name will appear in the supervisor list under Clients. The supervisor that is linked to the client is then the default supervisor on the note. This name can be changed at the time the note is written if the approver of the note is someone other than the default.
The notes approval workflow starts with The Unsigned/Unapproved Notes dashlet. All of the notes that are assigned to the supervisor and ready to be approved are displayed here. By clicking on the "Signed Notes Only" checkbox, the dashlet will show only signed notes.
Only signed notes are eligible for approval. To get a glimpse of the notes that will need future approval, uncheck the checkbox to see all notes that are still a work in progress.
Notes can be directly edited by clicking on the "Edit Note" icon. The note may be "Q'd" on the populated form or a .pdf version can be accessed from the "DMS" tab of the note.
Once the note is reviewed for accuracy and compliance, then the note will either be approved or it may need corrections. In the event that corrections are required, a task may be sent to the caregiver to notify them of the edits. This is covered in more detail in the "Managing Tasks" section of the user guide.
To approve the note, click the "Process" button. For companies that are using the timesheets feature, both "Approve for Billing" and "Approve for Payroll" will be visible. For companies that are not using timesheets, only "Approve for Billing" will be visible. Check accordingly so that the note may then travel the correct path to billing and/or payroll. When left unchecked, the note will move forward to the respective area.
When a note is marked as "Approved for Billing", this action effectively puts the supervisor’s signature on the note. If the supervisor’s signature is not a required component of the note, there is an option to approve, but not sign.
Signature control is managed under Configure—>List Configuration—>Services—>State Services. Uncheck the box for "Require Supervisor Signature" if a supervisor's signature is not required for the particular service. Note: this is configurable per service.
Enter the password to finish the approval of the note. This is the same password used to log in. Warning messages may be presented if anything about the note is out of compliance. These are the same warning messages that the caregiver received when they signed the note and chose to override. A decision may be made that the note is ineligible for approval until the warning messages are resolved. The system provides warning messages for the following:
The caregiver’s certifications are incomplete or expired
The client’s consents are incomplete or expired
There are not enough units left on the service authorization
The time on the note does overlaps with another note
Required fields are missing
If these messages are overridden, then the note will continue to be approved for either billing and/or payroll.
Once the note is approved, it will no longer display in the dashlet on the dashboard. A new DMS version is created on the DMS tab of the note that shows the final copy of the note, with or without the signature, based on the setting.
Filters are available on the left hand side of the "Search Clinical Notes" grid. These are useful for reporting on approved notes, unapproved notes, notes with open tasks, without tasks, etc. This can be a very powerful way of drilling into the notes to understand the various states that notes are in.
The only other way that a note can be approved is by a Super User. In the event that the assigned supervisor is not able to approve the note, then someone with Super User status may act as the stand-in supervisor. The Super User status is granted through securities. Super User mode is accessed by going to Options–>Super User. This power enables the user to open up a note and process for approval. When this happens, the Super User's signature is applied to the note, as long as the required supervisor signature checkbox is enabled. The Super User name is then listed as the supervisor on the note.