All Notes: How to Unapprove Notes and the Impact on Billing/Payroll
This section provides an overview of the workflow for unapproving notes and how it affects downstream processing.
When a note is unapproved by the supervisor (or a super-user) so that the caregiver can then unsign and make edits to the note, the impact the edits have on billing and payroll are automated.
From the billing perspective, this further re-enforces that notes reconcile to billing at all times. If the edit impacts billing in such a way that a re-bill must occur, the system is designed to automatically generate a new claim to either bill for more units or return units paid incorrectly.
From the payroll perspective, this functionality enforces that staff are paid for billable time that links directly back to the note. If an edit translates to overpayment for a staff, then a negative time record will be created and hours deducted from the next check run (or timesheet import). Likewise, if staff were underpaid based on the note edit, then the additional hours to be paid will cycle through on the next check (or timesheet import). The following will provide a view of the workflow as it applies to the various positons: from the caregiver and supervisor of the note, to the biller and to the payroll personnel.
For the caregiver, the note is created through their initial workflow; it is entered, saved and then signed. If edits need to be made to the note, they must understand if the note has been approved. If it hasn’t been approved, then they will unsign the note, make edits, save and sign.
If the note has been approved, then they must send a task to the supervisor requesting the un-approval. This is done under the tasks tab of the note that needs to be unapproved. Once the note is un-approved, the caregiver can then proceed with unsigning, editing, saving and re-signing.
For the supervisor, if they are informed that a note needs to be corrected, either from the biller because the note denied or from the caregiver because they realized a mistake, then the supervisor will need to unapprove for billing and then determine if they should also unapproved for payroll. It is always required to unapprove for billing, as that is the only way that the caregiver can un-sign the note in order to make edits.
A determination should be made on whether or not the note should be unapproved for payroll by answering the following question: “Is it okay for the caregiver to get paid the pre-existing time on the note?”
If the answer is yes, then there is no need to unapprove for payroll. The existing time will continue to flow thru the payroll cycle (or to the timesheet). Any edits that cause a difference in payroll will be imported to actual time (or timesheet) as a revision and captured on the next payroll cycle, if the current one has already been run.
If the answer is no, then uncheck the approve for payroll box. If the note has already been imported into payroll (or timesheet), then a check will not be created until the note is re-approved and re-imported. If the note has already been paid on a check, then the difference in the edit will come through on the next pay period. The most important thing to understand is that un-approving the note will stop payroll and a check cannot be created until the note has been re-approved or the associated time record is set to Hold-Pay in Actual Time.
For the biller, the typical routine is to import the notes to actual time, then import into batch billing in order to create invoices (OnTarget Back Office). The Enter Actual Time Grid should be used for all importing. This screen has color-coding capabilities to better help the biller understand the various states of the time records and what will potentially affect billing or payroll.
Once the RA’s are posted, it is then time to work denials. When working the denials, the biller will need to understand when a denial impacts the note, which then warrants a note correction. A good example may be that the wrong service code was billed. In that case, the note will need to be updated in order to reflect the correct service code.
To make that happen, the biller will notify the supervisor of the note to un-approve and the nature of the correction. Once the note has been corrected by the caregiver and re-approved by the supervisor (or super-user) the corrected information will import into the Actual Time and the system will automatically generate a re-bill.
Billers have the ability to look at time records in a billing view and a payroll view. This allows users to hone in on what to anticipate from either the billing or payroll perspective.