Physician Dashboard, Service Orders, Outpatient Pharmacy, Inpatient Pharmacy and Multibilling screens will now show the insurance limit threshold information for services and products that are going to be sent for their approval. This enhancement will let you visualize if you're still complying with the insurance threshold when you sum up your charges.
To check this process while peforming the application of charges and their billing, go to any of this mentioned windows and select the Encounter where you have performed insurance charges.
In our example, we took Service Orders screen, where you must select (or create) a Service Order:
If you're performing this step, you will be taken to the Application of Services window, three new lines will appear in the service header, to the right of the Encounter information:
Limit Threshold. Which is the insurance threshold limit for encounters (set in Insurance Policy Manager according to the policy coverage).
Total Request. Sum of requested services, if they exceed the threshold limit this amount will turn yellow.
Total Charge. Sum of total charges, if they exceed the threshold limit these amounts will turn red.
Phyisican Dashboard:
For Physicians Only
Service Orders window:
For Services Personnel (Image, Laboratory, etc.)
Outpatient Pharmacy window:
For Pharmacists Only
Pharmacy Dashboard (Inpatient) window:
In this example there is no assigned policy limit so there is no threshold amount added.
For Pharmacists Only
Multibilling window:
Note:
If you need to learn how to apply a policy or any step from this process, check this article with the entire application of policy limits from Apollo.
Updates:
Pop-up for Encounter Policy Limits
April 25th 2022
Policy limits pop-up window to visualize discharging of limit threshold for insurance policies.
We have just improved our limit threshold section where for patients that have an assigned policy you will be able to visualize a Limit threshold button - instead of the current list - that will open a new pop-up window with all of the encounter applied charges and requests and policy related fields for this encounter, allowing you to check if this encounter amounts are still within the limit threshold.
Example:
The columns that will be included here are:
Patient Type*
Product Class*
Maximum Limit
Limit Threshold
Follow up Limit (if there is any, if not follow up encounters will be within the Limit Threshold)
Total Requested
Total Charged
*New fields that are also a part of the new policy configuration per patient and product class. Check it here.
This button will be visible on Physician Dashboard, Service Orders, Outpatient Pharmacy, Inpatient Pharmacy and Multibilling screens and it will look as follows:
May 9th 2022
Approval Limits Improvement for Follow-up Encounters
When delivering services and medications during a follow-up encounter, you will now be able to visualize the follow-up limit column and also a new column for previous charges on Limit Threshold option, enabling you to perform collection of charges for our two different scenarios:
When follow-up charges will be added with the previous encounter charges
In this scenario follow-up encounter will be covered by the same policy limits as their previous encounters so there is no Follow-up limit set.
First encounter charges and requests:
Here, Follow-up and no Previous Encounters columns are not being displayed.
Follow-up:
Here you can see that Follow-up limit column has zero amount so the current charges and medication requests will be within the Limit Threshold. Also Previous Encounters (new column) column will show what has been covered already for this limit:
When follow-up encounters will be covered by Follow-up limits:
First encounter charges and requests:
Follow-up and no Previous Encounters columns are not being displayed.
Follow-up :
In this scenario we have a Follow-up limit for charges and requests so every added item will be covered by this limit. Previous Encounters are not being considered for this scenario so their amount will always be zero:
Update Notes:
If a Policy has follow-up limits, separately from their original Limit Thresholds, these limits must be added on Insurance Policy Manager for Apollo:
Follow -up encounters must be confirmed as follow-up in Encounter window :
We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.
Date: February 28, 2022