Point of Care Ideas

Current Situation / Problem:
Authorized units are often calculated manually using spreadsheets or individual judgment. This becomes especially error‑prone when authorizations specify:

• Specific days of the week for service, and

• Varying month lengths that change the total number of service days

  • Examples:

    • Weekly: “20 hours per week” or “80 units per week.”

    • Specific days: “6 hours per day on Monday, Wednesday, and Friday” or “24 units per day on Monday, Wednesday, and Friday.”

    • Daily: “8 hours per day, 7 days per week” or “32 units per day, 7 days per week.”

    • Monthly caps: “Up to 160 hours per month” or “Up to 640 units per month.”

These manual calculations increase the risk of under‑utilizing or over‑utilizing authorized hours, which can impact compliance, billing accuracy, and operational efficiency.

Stakeholders Impacted:

• Scheduling teams

• Care Managers / Case Support Managers

• Billing and AR teams

• QA and Compliance

• Branch leadership

All of these teams rely on accurate unit calculations to ensure services are delivered within authorization limits.

This enhancement would reduce calculation errors, improve compliance with authorizations, and eliminate time spent recreating spreadsheets or recalculating units each month.

Staff would have a reliable, standardized tool that ensures authorized units are consistently and accurately calculated, leading to:

• Fewer authorization overruns or shortfalls

• Improved confidence in schedules and billing

• Better audit readiness

• Time savings across multiple departments