Resource Corner Blog

5 Steps to Manage Waste | Measure Appointments Against Progress Notes


Your outpatient agency works hard.  You work hard to promote your services to the community.  You work hard to convince those who need help to seek it out.  You work hard to break down the stigmas so that those who need mental health or substance abuse treatment will call you, and more importantly, continue to see you while you provide them with the care and support they need.  Whether its accepting client referrals, scheduling appointments, providing services, billing insurance companies, or reporting outcomes, you work hard to build an agency infrastructure that can provide your clients with a model that allows you and your clients to achieve maximum results.

Make no mistake, your agency works hard. 

It is because of all that hard work that you need to ensure you are being compensated for all billable services.  The easiest and ideal way to do this is to regularly measure your scheduled appointments against your completed progress notes.  You need to add appointment to progress note reconciliation to your list of hard work items, otherwise you risk throwing some of your services right in the trash and losing revenue that is owed to you.

Yes – the payment model is changing.  Yes – Managed Medicaid is here.  Yes – performance based payments are inevitable.  And amidst all that, yes – you deserve to get paid for the hard work you do providing services to those in need.  With that in mind, below are my recommendations for how to effectively measure your appointments against your progress notes so you don’t throw away money for appointments you worked hard to get.

Step 1: Identify how long providers have to complete progress notes

Every agency is different, but you should have a pre-determined length of time that is imposed on service providers to ensure completion of their progress notes.  Is it before they leave for the day?  Close of business the following day?  This length of time is your agency’s decision may be based on a number of factors including; regulatory requirements, internal clinical processes, billing processes, etc.

Step 2: Measure the number of appointments by status

For outpatient clinics, measuring your appointments against your progress notes should be done at least a couple times per week for those agencies that bill on a weekly basis.  Let’s consider a single day with 30 appointments scheduled for the sake of simplicity.

So for Monday, I know that I have 25 billable services that were conducted.  From a maximizing revenue standpoint, I need to ensure there are 25 corresponding progress notes for these services. 

Step 3: Run a report for the day’s progress notes

Once you know how many scheduled visits actually took place, someone in your agency should have the role of checking that each visit has an associated progress note tied to it.  Running a report for the same day’s progress notes will help you determine how many notes are ready for billing.

You will want to check your progress notes for three items: 

  1. Has a note been written
  2. Is it tied to the correct appointment
  3. Is the note signed/completed

All Levels of Care and Treatment Modalities in eCR™ contain Appointment to Progress Note Reconciliation reports to help you manage this process. Read more.

Step 4: Institute follow-up procedures

Whether it’s escalated alerts to supervisors or individual reminders, you should have a plan in place to follow-up immediately on incomplete progress notes.  All it takes is one progress note to prevent you from clearing the days appointments for billing, so be ready to enforce your process so that your agency can bill promptly for services after they are provided.

Step 5: Check your progress notes multiple times during the week

I do not recommend approving services for billing until you are ready to approve the whole day. Medicaid APG Bundling dictates that if more than one service was provided to an individual in a day, they need to be bundled for billing.  If you clear progress notes for billing without clearing the whole day, you risk missing services that needed to be bundled, making it likely a payer will reject the second claim causing you additional time and effort to reconcile or worst case, not ever being paid for the service in question.  

Many outpatient agencies have different personnel with different processes, but assigning someone or some function the responsibility of reconciling progress notes with appointments is worth the time and effort to ensure you bill for every service you should be billing for.  Follow these steps to ensure your agency doesn’t throw away any money you already earned.

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