Chapter 34: Complete Patient Journey
Chapter Overview
This chapter is an end-to-end map. It does not replace the detailed chapters — it tells you which chapter to open at each phase.
Text-only. Two journeys: full EMR and billing-only.
34.0 Hard Rules (read first)
These prevent the most common mix-ups:
- SOC starts at Admit Patient — not from Care Order Actions or Schedule Center.
- OASIS assessments are not created in Schedule Center — SOC = intake; ROC / Recert / Discharge / Transfer / Death = Care Order Actions.
- HHA Care Plan is a document — Create / Save & Activate from the assessment when HHA is ordered; not a visit you schedule.
- QA Approve & Finalize makes the Care Order Active — then you schedule routine visits. Signature attention (and auto-fax when Communications is on) can continue after Active.
- Claims Center / Payment Posting are not available in sandbox — use production (or billing-only production) to bill.
34.1 Full EMR Journey
A) Agency ready (before patients)
| Phase | What happens | Read |
|---|---|---|
| Setup | Agency, branches, payers, users, clinical settings, visit types / rates | Ch 4–8, 10–12 |
| Communications | Usage, fax/SMS notifications (when ACTIVE) | Ch 9 |
| Go live (if sandbox) | Agreements + convert (demo clinical/billing data wiped) | Ch 13–14 |
| Referral sources | Physicians / facilities | Ch 32 |
B) Clinical episode
| Phase | What happens | Read |
|---|---|---|
| 1. Admit | 8-tab intake → Admit Patient → Care Order + SOC created | Ch 15 |
| 2. Complete SOC | OASIS or Non-OASIS assessment; HHA → Create / Save & Activate document if ordered | Ch 16, 19, 21 |
| 3. Pre-SOC packet | Admission packet required before Start Visit on SOC (+ optional HHCCN/ABN/NOMNC) | Ch 24 |
| 4. Finish assessment → QA | Submit to QA → Approve & Finalize → Care Order Active (+ physician signature attention / auto-fax when Communications allows) | Ch 22 |
| 5. Schedule routine visits | Schedule Center (Active Care Orders; Service vs Visit Type by payer) | Ch 25 |
| 6. Prior auth | Edit/approve PA as needed (auto-created on episode activation) | Ch 26 |
| 7. Deliver care | My Schedules → Start / Continue Visit; meds / wounds as needed | Ch 17, 18, 20, 24 |
| 8. Ongoing episode | Recert / ROC / Discharge / Transfer / Death from Care Order Actions (not Schedule) | Ch 16, 21 |
| 9. OASIS to CMS | Export XML → upload in iQIES → Mark as Submitted (production) | Ch 23 |
C) Revenue closeout
| Phase | What happens | Read |
|---|---|---|
| Claims | Production: Ready for Billing and/or New Claim (UNIT_BASED) → Submit | Ch 27 |
| EVV | If Alt-EVV: fix Call In/Out; Betasky EVV claims need Verified | Ch 28 |
| Payments | Payment Posting / auto 835; Exceptions if unmatched | Ch 29 |
| Residuals | Follow-ups, Patient AR | Ch 27 |
| Payroll | Mark visit time paid / export | Ch 30 |
| Reports | Census, episodes, missed, recert, Claims Report | Ch 31 |
34.2 Billing-Only Journey
| Phase | What happens | Read |
|---|---|---|
| 1. Signup / approval | Billing Only signup → agreements → activate (no sandbox wipe) | Ch 1, 13–14 |
| 2. Setup | Payers (unit-based catalog), physicians, agreements | Ch 6, 32, 13 |
| 3. Patients | 4-tab Add Patient (no care order / SOC) | Ch 15 |
| 4. Claims | New Claim + Billing Source (e.g. Sandata) | Ch 27 |
| 5. EVV (if enabled) | EVV Center | Ch 28 |
| 6. Submit / track | Stedi or manual; Exceptions | Ch 27 |
| 7. Payments | Payment Posting / 835 | Ch 29 |
| 8. Reports | Claims Report only | Ch 31 |
Not in billing-only: Schedule Center, Care Orders, QA, OASIS, Communications, Payroll, Ready for Billing, Clinicians list.
34.3 Navigation Reminder
See Chapter 2 for full EMR vs billing-only sidebars, and which billing items are sandbox-hidden.
34.4 Quick Checklists
Full EMR
- Agency setup + (if sandbox) go-live understood
- Patient admitted → SOC completed → HHA document activated if ordered
- QA Approve → Active → then Schedule Center for routine visits
- Production: claims submitted → EVV clean if needed → payments posted
- Exceptions / Follow-ups / Patient AR cleared
Billing-only
- Account approved; payers + physicians ready
- Patients added (4-tab)
- New Claim → submit → payments → Claims Report
Start over (sandbox EMR): Chapter 1: Sandbox Signup
Start over (billing-only): Chapter 1 § Billing Only → Chapter 14