Assigning Levels of Care (LOC)

The Kipu EMR allows facilities to customize the Levels of Care (LOCs) offered by their organization. There are two ways to assign LOCs: 

• Authorized (UR) Level of Care: Assign a Level of Care to the patient when adding an insurance authorization to the Utilization Reviews section of the patient facesheet.  
• Clinical Level Of Care: Providers can assign a Level of Care to the patient when completing an Evaluation. 

Need to make updates to your available LOCs? Check out these configuration instructions. 

Why would I need to assign two different LOCs?

Clinical Levels of Care are typically used to document a LOC for non-insurance patients instead of adding an insurance authorization in order to bill the patient for per-diem services. However, Clinical LOCs can also be used when the patient's Authorized (UR) LOC is not what will be provided to the patient. This typically occurs when the insurance doesn't authorize the needed LOC (typically authorizing a lower LOC), but your organization chooses to provide the needed treatment in the form of a higher LOC.

By assigning both LOCs, your organization can better manage patient treatment.

Adding an Authorized (UR) LOC to the Patient Chart

Users with the Utilization Review Internal role or users with the Manage Utilization Review feature added to their profile can add Authorizations to the Utilization Reviews section of the patient facesheet. For complete instructions on adding authorizations, click here. 

1. From the Patient Information tab, scroll to the Utilization Reviews section. 
2. Click Add Review. This is the only option here that allows you to add a Level of Care.
3. From the Authorization window, enter the known authorization information. (Fields with asterisks (*) are required.) Hours entered in the Hours Per Day field will appear in the expanded view of the related billable item under the Duration Met/Required Duration and Duration sections.
4. Assign the Status from the drop-down and Click Save Authorization.
   • New: Use the New status immediately after creating a new utilization review. This status indicates that the review is in draft form and is not yet submitted for approval.

   • Pending: Use the Pending status only after the utilization review has been formally submitted for approval.

   • Approved: Use the Approved status only when the utilization review has received formal authorization.

   • Denied: Use the Denied status only when the utilization review has been formally rejected.
     New UR Vs. Updating Existing UR

   • New UR: Create a new Utilization Review (UR) when a patient receives a new authorization accompanied by a new authorization number, when a new Level of Care is being authorized, when an existing Level of Care is extended with a new authorization number, or when the patient transitions from one Level of Care to another—for example, moving from Residential to Detox.

   • Update UR: Update an existing Utilization Review (UR) when the authorization is extended but the authorization number remains the same, or when there is a change in the authorization status, such as moving from New to Pending or from Pending to Approved or Denied.
     

5. The authorization appears below the Utilization Reviews sections.

View LOC History

You can view a patient's authorized (UR) Level of care history by clicking the Hx Level of Care button.

When viewing a patient's LOC history, please note that the current date represents the current Level of Care.

Adding a Clinical LOC to the Patient Chart

Clinical LOC is managed only in evaluations and not on the patient's facesheet. The clinical Level of Care can be assigned using any evaluation containing the patient.level_of_care_clinical field. One of the most common forms where this field appears is Manage Clinical Level of Care. 

To add a clinical LOC:

1. From the patient chart, open the tab where the clinical evaluation is assigned. Evaluation assignment varies based on your organizational setup. The easiest way to confirm the location of the form is by editing the form from the Templates > Evaluations tab and reviewing the tab name in the Patient Process drop-down. 
2. Click Add form. 
3. Locate the form title and click Add.
   
4. Click on the Edit icon.
5. Select the date you're adding the clinical LOC. Then, assign a level of care using the Transition to level of care drop-down.
6. Complete the form. Once all the necessary signatures are collected, the patient will be assigned to the specified LOC.

Click here for information about billing the patient for per-diem care using Clinical Level of Care.