Authorizations: WebPT EMR + Billing
Let’s review how authorizations work with the WebPT EMR and Billing. In this article, we’ll address the most common questions and scenarios encountered.
- How do I add an authorization in the WebPT EMR?
- When do authorizations flow into Billing?
- What happens if I add an authorization after a note has been finalized?
- What rules do primary authorizations follow once in Billing?
- What rules do secondary authorizations follow once in Billing?
- What happens when an authorization expires or runs out of visits?
- How do I add a backdated authorization to a past date of service?
- What happens if I need to addend a date of service that has an authorization attached?
- Where can I see authorizations in Billing?
- When is the authorization count updated?
How do I add an authorization in the WebPT EMR?
Authorizations are added to the patient’s case in the WebPT EMR, either during the initial case creation or later by editing the case. Click here to learn how to add an authorization.
Important: You must include the Authorization #. If you do not have the auth number, you can enter 0000 to bypass the system requirements and allow the authorization to flow into Billing. Otherwise, the authorization will not flow into Billing and all related claims will be placed on the Delayed Claims report.
When do authorizations flow into Billing?
There are a few rules which guide authorization integration into Billing from the WebPT EMR once the authorization has been added to the patient’s case and the patient has been saved. These apply to both primary and secondary insurance authorizations.
- The authorization flows into Billing as soon as you save the patient as long as the date you add the authorization is within the authorization effective dates.
- For example, if the auth effective dates are between 12/1 and 12/31, adding the auth on 12/1 works, 11/30 or 1/1 would not.
- Otherwise, the authorization will flow into Billing if a date of service within the authorization’s effective date range is finalized.
- For example, if the auth effective dates are between 12/1 and 12/31, and the date of service for 12/6 is finalized, the authorization will integrate and attach to all the dates of service within the effective date range.
What happens if I add an authorization after a note has been finalized?
In situations where one or more notes were finalized before the authorization was added to the patient’s case, the authorization will automatically attach to all relevant charges starting with the oldest date of service. As previously mentioned, the authorization will only be attached to dates of service that fall within the authorization’s effective date range. Any dates of service being held on Delayed Claims will be automatically released once the authorization is attached.
What rules do primary authorizations follow once in Billing?
The following rules dictate how authorizations impact charges and the system once the authorization has been imported into Billing.
- If the authorization is present on the patient’s case and is valid for the Date of Service, it automatically attaches to the charges when billed.
- If an authorization is not added to the patient case and the insurance is not set up to require authorizations, then the claim will bill without an authorization attached.
- If an authorization is not added to the patient case and the insurance is set up to require authorizations, the charges automatically appear on the Delayed Claims report. These claims will not bill until the authorization is added.
What rules do secondary authorizations follow once in Billing?
The secondary authorization must be manually attached to the charges prior to billing the patient's secondary insurance.
What happens when an authorization expires or runs out of visits/units?
When a note is finalized after the primary authorization expires or runs out of visits, the date of service is automatically placed on Delayed Claims for No Authorization. When you receive the new authorization, there are a few things to remember when updating the patient’s case:
- Never add a new authorization where the Effective Start date overlaps with the Effective End date of the previous authorization. The system will not know which authorization should be followed and this will create problems with authorization attachment and reporting. We recommend updating the previous authorization’s Effective End date to be the day prior to the Effective Start Date of the new auth.
Once the authorization is added to the patient’s case, the authorization will automatically be added to all relevant claims on the Delayed Claims list, starting with the oldest date of service. Claims will automatically be scrubbed to be billed that evening. Remember, if the DOS does not fall within the effective date range, the authorization will not be added and the claim will stay on Delayed Claims.
How do I add a backdated authorization to a past date of service?
If the date range of the authorization has passed (i.e. Today is 2/11/2020 and the authorization effective range is 1/1-1/31/2020) and you have additional notes to finalize within the authorization date range (i.e. Date of Service 1/28/2020); finalizing those notes will automatically pull the authorization into Billing. There are no additional steps needed.
However, if you do not have additional dates of service that need to be finalized within the authorization's effective date range, you'll need to push the authorization into Billing. Complete the following actions depending on your service level.
This process describes how to add retro authorization either by
- Completing an addendum
- Adding authorization manually into WebPT Billing
Once you've obtained the authorization, add it to the patient's chart in the WebPT EMR. Then, email email@example.com so they can attach the auth to those charges.
We recommend adding the authorization into the WebPT EMR and asking the therapist to addend any note within the authorization's effective dates. This ensures the authorization flows into WebPT Billing and will automatically attach to all dates of service within the effective date range.
If an addendum cannot be completed, you can manually add the authorization in Billing and choose whether to automatically apply to all dates of service or manually attach it to the correct date of service.
There are two scenarios of adding into Billing depending on whether or not the patient is Active or Discharged. Bother processes are described below:
Adding Retro Authorizations to the EMR & Billing for Discharged Patients
- Navigate to the patient’s account and click Cases.
- Double-click on the Case Name to open the details.
- Click the Edit button at the bottom of the screen.
- Open the Primary Insurance tab and click Add New Pre-authorization.
- Complete the authorization information and click Save in the bottom right. Click here for more information about the Save options available when editing a case.
- In the Preauthorization window that appears, you'll be able to see the dates of service the authorization was automatically attached to based on the effective date range and the available visits or units.
- To manually add the authorization, navigate to Error Corrections, and follow these instructions.
Adding Retro Authorizations to the EMR & Billing for Active Patients:
- Add your retro authorizations into the EMR.
- These authorization will NOT integrate assuming the date range is before today’s date.
- They WILL integrate if you finalize a DOS within the authorization date range or complete an addendum for a DOS within the authorization date range. If you choose not to complete an addendum, continue steps 2-4.
- In WebPT Billing, search for and open the patient account in question, then navigate to “Cases” and click to “Show Inactive Cases”. If you have multiple retro authorization to add, you can use 1 inactive case and add all retro authorization to this 1 case.
- Make sure to choose an inactive case that has the same insurance needed and the same case details (Case Name…etc.).
- If adding multiple retro authorizations, you may add these all to one reactivated case, just make sure there are no overlapping dates.
Important: If the authorization is manually added to the current active case in WebPT Biling, any new updates in the EMR that integrate will inactivate the current case and keep all charges. However, the manually added authorization will only be attached to the inactivated case.
- Before you add the retro authorizations to the cases you’ve reactivated, you’ll want to “Charge Case Transfer” the charges for each DOS respectively to each authorization, from the current active case (the case that existed before you reactivated any additional cases) to one of the reactivated cases. This is recommended to be completed first before you add the authorization to the case so that you are prompted to attach the authorization to each charge.
- Add the Retro Auth(s) to each case and click Save. You should be prompted to attach the authorizations you’ve just added to the charges in the case. If not, this can be manually completed via Charges > View Charges > Edit Charges or Error Corrections.
Note: If you choose to complete an addendum to integrate this newly added retro authorization, you will not need to complete steps 2-4 above.
Testing has validated that an addendum or completion of a new daily note, correctly imports the authorization into Billing and automatically attaches the authorization to any visits within the authorization date range.
*For discharged patients, you may add the retro authorization directly to the current active case in WebPT Billing without the need to reactivate any inactive cases.
What happens if I need to addend a date of service that has an authorization?
If you finalized documentation on the wrong patient, addend the note and no charge the visit. Email firstname.lastname@example.org and request those charges be removed. The authorization count will be inaccurate until those charges are inactivated in Billing.
If you addended the note to update the number of units or CPT codes billed, no additional action is needed on your part. The system will automatically handle these types of changes.
Where can I see authorizations in Billing?
Once the authorization is added to the patient’s case in the WebPT EMR, you’ll be able to view them under the Primary Insurance section of the patient’s case.
To view the authorization:
- Navigate to the patient’s account and click Cases.
- Double-click on the Case Name to open the details.
- Click on the Primary Insurance or Secondary Insurance tab.
- You can view the authorization details in the Pre-Authorizations section.
When is the authorization count updated?
Once the authorization is attached to the charge in Billing, the visits or units used count will be updated. The system does not wait until the charge is billed to update the used visit or unit count.