List Configuration: How To Setup Service Menus
Service configuration can be found by going to List Configuration–>Services.
This section contains information for the setup of client insurance information.
Funding Agents: The funding agent is a critical piece of information in the insurance setup, as this indicates the entity responsible for paying the services rendered. The funding agent is assigned to the client in the Insurance tab of the client record. This is a required field in order to save the insurance information. Without this information, an authorized service cannot be entered (required for billing). Even if billing is not going through OnTarget, but the intention is to implement notes, the insurance record is still required for the necessary service setup within the client record. Funding agents are added by entering in a payer code and a payer name. Note: if billing through OnTarget, the creation of a funding agent requires a more detailed setup, which is handled through the Back Office. Funding agents are referred to as "payers" in the OTBO setup. Typically, the assigned Aym representative will complete this detailed setup since this information is critical to how claims are paid. For reference purposes, payers are managed in OTBO in the Accounts Receivable–>Setup–>Maintain Payers screen.
Service Funders: Service funders are critical as they represent the insurance carrier. This information should be taken directly from the client’s insurance card. Like the funding agent, service funders are also assigned to the client in the insurance tab of the client record. They will be listed in the source drop-down and is a required field on the insurance record for both billing and note-writing purposes. Service funders are added by entering in a code and a description. Service funders are referred to as "funding sources" in OTBO. Funding sources are managed in OTBO in the Billing–>Setup–>Maintain Funding Sources screen. These are typically completed at the onset of implementation by the assigned Aym representative and are then maintained by the assigned OnTarget Administrator as new funding sources are accepted in an organization.
This section contains information for setting up note keys and note templates.
Note Keys: If grid notes are being implemented, note keys will need to be set up. These keys are the method in which goals are addressed. Typically, the keys are used to show the intervention that was provided against each goal and then an assessment is made to indicate whether or not those interventions assisted the client in reaching the goal. There is full control over how key types are set up. Keys may be set up uniquely for each service that is provided. This allows the keys to be tailored to each of the service’s documentation requirements.
To start configuring note keys, from the Configure Desktop, click on List Configuration—>Services—>Note Keys. Click on "Add Note Key" and select whether the key is an intervention or assessment key. Key types other than intervention and assessment labels can be requested by going to Options—>Contact Support. It is important to note that any new key type will not be able to be graphed to measure progress so it is recommended to use the intervention and assessment key types. Enter in the key abbreviation under code. This is how the key will be displayed for the staff when their note is created. Next, the "Is a Comment" checkbox is available to designate the key as a comment. This allows the user to type in a comment in the resulting note key. Next is the key description. This will show up on the note report in the form of a legend. If a comment is required to be entered on the note when a particular key is used, check the "Require Comment" box. The staff will then not be able to save their note unless a comment is entered into the comment field. Click Update to save the record. If the key needs to be edited, click the Edit icon. To delete it, click delete. Repeat these steps to continue building the keys. The keys will display on the note in the order they are presented in the list view. To change the order, drag and drop the keys until they are in the desired order. Below is an example of some intervention and assessment keys for a resulting note.
Note Templates: The system provides three standard note templates: a Clinical note, a Grid Note and a Medical Note. Additional note templates can be configured if there is a need to customize note forms.
A Clinical Note template is based off the PIE Note format, where three separate text fields capture the Purpose of Contact, the Interventions provided during service delivery and the Effectiveness of those interventions. The Purpose of Contact section is designed to link to the goals that are setup in the treatment section of the client record. Note: the three text fields can easily be renamed to see a different title for each section. That is handled by going to the Custom Labels screen in the Configure Desktop.
A Grid Note template is based off a grid format. It is designed to list goals from the treatment section of the client record in rows so that intervention and assessment keys can be assigned to each goal in a grid format. The keys are customizable per service code and configured in the List Configuration screen under the Services section.
A Medical Note template is a very simple format. It is designed to sync the Vital Statistic information from the medical section of the client record. There is also the capability to sync the medications and/or the DSM5 information from the medical section of the client record. To link the medications and the diagnosis information, email a request to firstname.lastname@example.org. The template provides a default long text box. Additional fields can be added to support a particular agency's version of a medical note by going to the custom fields screen in the Configure Desktop.
The default templates can be renamed with a specific title for a note that users will identify with. A new note template can be added if a modification is needed to any of the three default templates in order to meet your documentation requirements. With any note template, whether the defaults or a new one, users have the flexibility to add custom fields and/or rename any of the default labels. This expands the system’s ability to support a particular agency's specific note forms. There is no limit to the number of templates that can be created.
Give the template a description. This will be the common name for this note format, meaning this is how the note will be referenced in the drop-down selection list for note templates. Select a Note Type.
The Multi-day checkbox should be used when needing to capture multiple time events on a note; whether multiple dates of service, such as on a weekly or monthly note, or multiple start and end times within a single day. If this is not checked, then the system will only allow one time entry per date of service. Users can control which note templates are active, and therefore eligible for notes to be written against. If the template is not active, it is not visible in the notes desktop and a note cannot be written against that form. The clone button can be used to copy one template to another.
This is most useful when there are a lot of custom fields configured to a template and several of the fields need to be modified. It may be important to preserve the original template and create a new one to reflect the modifications.
This section contains information for setting up service masters and state services. It is important to note that if services are being billed through OnTarget, then an Aym representative will complete the service setup. The billing configuration for services is handled through OnTarget Back Office as the Clinical side of service setup is typically only done if the services will not be integrated with billing or payroll. If only scheduling and notes are being implemented and timesheets or billing are not going to be used, then services can be added through the following steps:
Service Masters: Services should first be entered here. The service code should reflect the HCPC code of the service only; if the service has a modifier, the modifier is NOT included in this field. Modifiers are entered under the Procedure Modifiers section. This is very important for billing purposes. Service Abbreviation represents the common name for the service and is how users will see the service in the various drop-downs throughout the program. The service abbreviation can be edited at any time with no impact. Service Name should represent the full description of the service. Rate type is the service parameter for billing reimbursement purposes, whether the service is reimbursed per 15 minutes, per hour, per daily event or on a weekly or monthly basis. The fee schedule should provide that information. The units entered are based on the rate type. If the service is reimbursed per 15 minutes, then you would see rate type of periodic and units of 4. If hourly, daily, weekly or monthly, a unit of 1 is entered.
Note that Service masters are simply referred to as "services" in OTBO. Services are managed in OTBO by going to Billing–>Setup–>Maintain Services. OTBO offers more control over the service set-up, and is the preferred method (typically completed at the onset of implementation).
State Services: Once the service is configured in the Service Master screen, it will then need to be added to the State Services screen. After clicking on the add button, select the service. This is pulled from the list of services configured at the Service Master screen. Next is the option to set the default note template.
This is recommended when notes are being documented against a particular service to ensure that users are completing documentation against the correct form. Note templates are setup under the Services section of List Configuration. Group service is an important checkbox to mark for services that are provided in a group setting. This will allow staff to write multiple notes for the same timeframe in order to document against each client participating in the group session, while still only paying the staff for their true time. Without the group service designation, the staff’s hours on the timesheet would be over-exaggerated and the notes would be considered overlapping time. Duration only is an important decision to make before a service is ever used in the system. Time can be entered with a start time and an end time or for a total duration for the day ex. 8:00am-9:00am vs. 01:00. Every entry point for service information will require the time to go in per the choice that is made…at the schedule, the note, the timesheet and in billing. Consult the service record requirements when making that decision. It is very complicated to change this setting once data has been entered, so it is recommended to put considerable thought into this prior to managing the service in the system. This setting is service specific, so while one service may be duration, others may be configured as start/end time. Require supervisor signature is marked for all services in which the note documentation must show both the staff writing the note’s signature as well as the supervisor’s. When left unchecked, only the caregiver’s signature will display on the note. Again, this is service specific. Lastly, if grid notes are implemented then it will be important to configure the note keys. Check off each key that is associated with the selected service. These are also service specific. If a key is not listed, it can be configured under the Note Key section of the Services section of List Configuration.
Create note from schedule only is a feature that is highly recommended as a means of managing service delivery for unit utilization and has proven to be very beneficial in reducing denials for exceeding units. This was previously a global feature that applied to all services and was found under Edit Company Settings as "Lock Note on Scheduling". Now this feature applies to state services individually (see screenshot above). When this rule is enabled, a note-writer cannot add any notes for time that is not represented on the calendar. All billing related fields on the note are locked down (client, service, service date, caregiver, supervisor) and the only fields that can be edited are the time (either start/end time or duration, depending on the service setup). Scheduling services in OTC pro-actively allocates units per week/month/authorization period. With that in mind, any time the note time changes from the scheduled time, overages in time will likely throw an exceeded units validation….which if not override-able, will force communication to a scheduler so that the amount of overage hours can be reduced from another day. This effectively reduces a service from being over-provided.
When a staff goes into add a note, the client/service date/service fields will be open for selection.
When the service is selected, If the service is set up to enforce the selection of a schedule link, then a message will immediately pop up notifying the user to go to the schedule link.
If the service is not set up to enforce a schedule link selection, then the user can proceed with entering in the details of the note (time, supervisor, etc…)
If this setting is enabled, note information can only be imported from scheduled events. This will also lock the header fields of the note. The time fields of the note are still editable by caregivers even if this setting is enabled.
Note: state services are typically set up in OnTarget Back Office. State services are managed in OTBO by going to Billing–>Setup–>Maintain State Services. OTBO offers more control over the state service set-up, and is the preferred method (typically completed at the onset of implementation). For detailed information on assigning note keys to services, see the "Assigning Keys to Services section of the user guide under the Notes Desktop section.