Home Forums Discussions Feedback and Recommendations Same Note in More than One Chart?

Hey folks,
Nancy is getting more and more into doing Pysch with family and marriage counseling stuff. There are some unique issues to charting and billing these types of encounters.

First off although you are sometimes "treating" or having an encounter with multiple members of the family or couple, you usually are only billing once to one of the patients in the group. Usually you start with the "identified patient", the one that has the obvious issues, although he or she may not be the actual root cause of the systems issues and dysfuntions.

Meanwhile all the family members are really your patient and one could really use to put the majority of this same repeating note in each and every member of the family or of that days encounter at least, note. But unlike now, AC creates and forces you to make a billed encounter for any note written.

Soooo, wouldn't it be nice to be able to:
1) create a note (sometimes quite long and complicated)that could then be linked or copied to other patients in the family, yet not have their note completed yet, so if you wanted to, you could then go back and add a last sentence or two freehand later that might be unique to that one family member. I envision a drop down or a set of drop downs, or a drop down that one could use repeatedly until all family members that you needed to add that note to, had a copy of it in their chart. And perhaps as this link or copy goes out, AC could give you the option to either sign the note right then and their or to have it go to a holding area (perhaps if needed the old inbox with other unsigned charts) for completion later.

2) For such charting we need to have AC allow us to chart an encounter that does not add to our encounter totals or requires the generation of an invoice, 1500 or what have you either. But instead have the encounter know for, linked to the original family member that is going to have their insurance actually billed.

In these types of settings on any one day you can have any combination of family members based on how things are or are not progressing and who needs attention for what. So this is not something that can be preset static like, but needs to be able to be tweaked and done up on an encounter by encounter basis most of the time. One day you may have the whole family and the next day you may only have the kids or the parent just as an example, so it needs to be flexible to each time. And the way insurance is, each family member has a certain amount of mental health visits so you are frequently switching around who is the actual billed party. Frequently by who was sort of the focus or IP that particular day....

Anybody else out there doing a lot of pysch? Would you like such features? How have you been dealing with these things so far?

Paul:

Have you thought about using an Excel flow sheet? That does not save as an encounter, but can be linked to one or multiple patients.

http://www.amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Number=6497#Post6497

You can also link OneNote files in this way.

I thought there was a time when you didn't like OneNote.

I just thought it was a useless memory hog, a gussied-up Notepad, the greatest thing from Microsoft since the talking paper-clip mascot!

What can I say? You showed me the light, Bert!

So, you want me to show you the light AND send you a bottle of wine. Geez!

Notepad is actually on of my favorite programs, though I usually forget its even there. It doesn't do much-- but it doesn't cost much, boots REALLY FAST, and lets you quickly do the essentials--type what you want really quick as a reference. No fancy formatting but....so what?

@Hockeyref,
What if you highlight the body of the note you want to use, then press "Control-C" and then close the current chart, (or sign it if you are done). If you are not done, of course you forward the chart to yourself. Now open the second family members chart, click on the box where the pasted section needs to appear and press, "Control-V", then you can, 1- forward this second chart to yourself for later, or 2- sign it right now, with or without a bill as needed.

DocM,
Not a bad idea. I sort of thought of that myself. But again AC wants, needs to have you create an invoice, a "billed" encounter, for each encounter, visit you chart. These should not be addendums, they are real visits, they are just being billed to one family member as opposed to each and every family member as if they all came in for multiple strep throat visits with tests.

Funny how four family members all with strep throat that are all in and out in 15 minutes or less could truely pay much more than working for for a clinical hour, with four very upset family members working through their multiple issues. One family psych visit vs. four level 3's and four 87880's for strep tests. Each level 3 on our region Medicare is over $56 dollars, each strep test is worth like $16, do the math. Now that is garbage.

But anyway, this is something that really happens in family medicine as well as Psych practices every day, it would be nice to have AC be able to accomidate it. But yes your suggestion is well taken.

Paul, I don't create invoices for any of my encounters (I use a printed superbill).

Just enter a level visit for the first family member. Then, with the next member, just sign the note without entering any CPT codes. It will give you two little warning windows to make sure you really want do this; just click through them.

You will have a record of a "real" clinic visit, with no associated level charge.

I would say that AC doesn't want you to FORGET to send a bill, but you CAN sign the chart with no bill. You have to click on "Sign Chart" then "No" you do not want to go back and add an ICD-9 (unless you DID add an ICD-9, which doen't matter), Then on the 'billing' page, again click "sign it" and "No" you don't want to add an ICD-9, and then you must chose "Yes" you are sure you want to sign the note without a procedure code,or E&M code. and it is done. It is signed and a part of the permanent record, but no super bill was created.

Guys,
Thanks to both of you. As you can see, our invoices are also generated by the provider doing the charting around here, so I'm a little shakey on that end of it. So it really is just a matter of copying the note itself multiple times then. Not so bad.

I have had another wish list thing. Being able to see and link family members and have most of the demographics page simply populate with the insurance info and like the plan and the subscriber, address and the like. Nothing like getting a new family and having to have to re-enter the same stuff half a dozen times.... See that's my side of the business now.

Anyhow, thanks for the insight...
Paul

Paul:

The linked family thing shouldn't be too hard, I wouldn't think, because Amazing Charts links people who live at the same address.

I did a mass mailing last week, and I noticed that it was creating one letter per household, not per patient, and it listed each household member's last name, if they were different!

Example:
DEWEY-CHEATHAM-HOWE FAMILY
1234 MOCKINGBIRD LANE
ANYTOWN, USA

It would be nearly impossible to use Windows completely without notepad. While it's not a great editor, it is pretty much the gold standard when it comes to writing batch files or opening .ini, .dat and a million other files.

Awww... who doesn't wuv wittle Notepad? It's so cute!

but powerful!

I wuv wittle Notepad too