Understanding the Pre-cert Count
The number of remaining visits for a pre-certification that display in the Pre-certs grid and on the Pre-Cert template can be different from the number on the NTS Homepage. The therapist who reviews the Pre-cert grid on the NTS Homepage needs to know in real time how many visits a patient has left including today's encounter. The pre-cert staff who work from the Pre-Cert template need to know how many visits have actually been used.
Pre-certs on the NTS Homepage
When the therapist reviews the Pre-certs grids on the NTS Homepage, the # column in the Pre-certs by Encounter/Visits grid includes today's visit and informs the therapist of how many visits the patient has left including today’s visit. The NTS Homepage has a tailored view (or count) for the therapist and reflects the number of pre-cert visits left as of the date of the encounter.
The system deducts one from the pre-cert count as soon as a billable visit type is selected on the NTS Homepage, but the number on the NTS Homepage does not change until the next encounter. If the patient has only one visit remaining, then when the therapist opens the NTS Homepage and selects a billable visit type, they see 1 (one) in the Pre-certs grid. The therapist can proceed knowing that the current encounter is covered under the pre-cert.
Pre-certs on the Pre-cert Template
The Pre-Cert template is called the "live count". The remaining visits reflect the deduction of today’s visit. It is the exact number remaining as of today’s date. The pre-cert staff needs to know how many have actually been used (and the system has already subtracted today’s visit) and how many remain. The pre-cert staff are not usually looking at the NTS HomePage; they go by the count on the Pre-Cert template.
Example of Pre-Cert Count Differences
For this example, assume the patient has an encounter for 10/25/2022. The NTS Homepage displays 14 visits remaining while the Pre-Cert template displays 13. An SOC (Start of Care) count of 32 represents only the number of encounters with the patient and does not reflect the pre-cert count.
On the Pre-certs by Encounter/Visits grid of the NTS Homepage, the current patient encounter is included in the 14 visits left, therefore, the grid reflects the visits used in previous encounters plus today’s encounter. The grid is read-only and not updated just because the NTS Homepage was opened. However, on the next encounter, the Pre-certs by Encounter/Visits grid will show 13 visits left.
The Pre-Cert Usage History template shows that PT Eval is not included in the pre-cert count because on the Pre-certification Config template, the Evaluation included in number of visits checkbox is not selected for the payer.