Plans of care

A plan of care sets what treatment a patient receives in one discipline for a period: how often, for how long, toward which goals and under which authorization. The Plans of care tab on a patient's chart lists every plan and recertification with its period, its standing, the visits used against its limit and the physician certification. When your clinic offers applied behavior analysis (ABA), a Treatment programs tab sits beside the plans with the learner's ABA treatment plan and programs.

Plans across your patients#

Open Plans of care in the Docs panel of the main menu to see the plans and recertifications of every patient you can see, newest period first, at the location you are working in. Each row shows the patient and chart number, the period, discipline, standing, visits used, certification and recertification date.

• Pick patients in the patient panel to see only their plans and move between patients without opening each chart.
• Click Filter to narrow the list by discipline. Sort by patient, period or discipline from the column headers.
• Type a patient's name or chart number in the search box to find their plans.
• Click a plan's period to open it in the document window. With exactly one patient picked, click New Plan of Care to write a plan for that patient.
• Open Certifications in the Docs panel to see the plans waiting on the physician.

Who can read a plan#

A plan of care is the treatment plan the whole care team works from, so everyone on a patient's care team can open every signed plan, recertification and amendment on that chart, its goals, PDF and print included, whoever wrote it. This holds even when their role shows only their own visits and notes under Other providers' visits and notes. Their daily notes read the plan's goals the same way. A plan still being drafted, and other notes such as another provider's daily notes and progress reports, follow that setting.

Plan standing#

Visits that count against a plan are the episode's visits in the plan's period, except voided ones.

Write a plan of care#

1. Open the patient's chart and click the Plans of care tab.
2. Click New Plan of Care. You can also start one from the Documentation tab: choose Plan of care as the type.
3. Choose the Episode, check the Template and set the Document date, then click Create Draft.

The plan opens in the document window. Above the template it shows:

• Plan terms: the Start date and End date (a new plan proposes 90 days from its date, or the certification length in the discipline's module settings), Sessions a week, Duration (weeks), Session length (minutes) and the Authorization the plan relies on. Turn on Set a visit limit to cap the visits yourself; otherwise sessions a week times duration is the limit. Only finalized visits count against the limit.
• Physician certification: see Physician certification.

Terms save as you type, like the rest of the draft. When the patient's primary coverage on the start date is Medicare, a plan can cover at most 90 days. If a term is missing or not a whole number, the status under the terms reads Terms not saved: fix the highlighted fields until you correct it.

Save, Sign and closing the document all wait for the terms and goals to save. If they cannot be saved (a field needs fixing, the connection is down or someone else saved them), the document is not signed and closing asks before dropping your changes. If the plan itself cannot be loaded, the document shows Try Again and cannot be signed until it loads.

Goals#

The template's goals section is where you write the plan's goals. Daily notes and progress reports read their goals from the plan, so this list is the one place goals live.

• Click Add Long-term Goal or Add Short-term Goal for a new goal. A short-term goal can sit Under long-term goal, the long-term goal it works toward.
• Click Add From Library to pick a goal from the clinic's goal library for the discipline. Type in Library goal to search the whole library by text or area. Its blanks fill in where NeatPractice knows the value: {{patient}} from the chart, {{n}} and {{cueing}} from the goal's defaults and {{timeframe}} from the plan's length. Any blank still left is listed under the goal; replace it with this patient's value.
• For each goal, set how it is Measured by (percent accuracy, trials, cueing level, frequency or duration), the Target, the Baseline, a Target date and its Status (active, met, partially met, not met, discontinued or modified).
• The Target follows the measurement: a percent above 0 and up to 100, a whole number of trials or times, or minutes up to 1440. Changing Measured by clears the target so you set it again.
• Set a goal's Domain, such as Articulation or Daily living, to group it by area (up to 100 characters).
• Optionally give a goal a structured criterion: increase or decrease, a start value and a target value, the unit (percent, occurrences, per hour, minutes or seconds), the period it is measured over (session, day, week or month), how many periods it must hold and a prompt level. NeatPractice writes the criterion as a sentence, such as Increase from 40% to 80% per session for 3 consecutive sessions., and rewrites it when you change a field. The start value must be below the target for an increase and above it for a decrease; a percent target is at most 100.
• Drag a goal by its handle to reorder the list. Goals save a moment after you stop typing, once every goal is complete; until then the status reads Goals not saved: fix the highlighted fields.
• If you remove a long-term goal or change it to short-term, its short-term goals say so under Under long-term goal. Choose another long-term goal or None before the goals save.
• A plan holds at most 40 goals, including those added from the library.

A goal you remove from a draft leaves the list but stays on record. Once the plan is signed, its goals and terms no longer change.

Goal comments#

On a signed plan, each goal has a comments button so the people treating the patient can talk about it, for example a supervisor and an assistant. The button shows how many comments are new to you, or how many there are.

1. Click the comments button beside the goal. Goal Comments opens with the thread, newest first. Comments you have not seen yet are marked New, and opening the thread marks them seen for you only.
2. Click Add Comment, write it and click Add Comment.

The Seen column shows who else has seen each comment; hover over it for when. You can remove a comment you wrote; it leaves the thread for everyone. Anyone who can read the patient's notes can read and add comments. A goal carried into a recertification keeps its thread. Comments are conversation about the goal, not part of the signed plan.

Goal chart events#

A chart event is a dated note that explains a change in progress: an illness, a medication or provider change, a schedule break, a home or school change, or a new device. Each one is drawn as a numbered line on the goal charts of progress reports and discharge summaries whose period includes its date.

The patient's Plans of care section lists them under Goal chart events, newest first. To add one, click Add Event, choose the Date and Kind, write a short Description, and pick the Goal it is about or All goals, then click Add Event. Use the row's menu to edit or remove an event. An event pinned to one goal stays with it when the goal is carried into a recertification.

Anyone who can read the patient's notes sees the events; adding, editing and removing them needs Notes: Author.

When terms or goals were saved somewhere else#

If someone else, or another window, saved the plan's terms or goals after you opened them, NeatPractice stops saving that part and shows that they were saved somewhere else. Your changes stay on screen. Choose Keep Mine to save your version over the other one, or Load Saved to show the saved version and drop your changes to that part.

Medicare medical necessity (KX)#

When a Medicare patient passes the yearly therapy threshold, billing adds the KX modifier only after the therapist attests that the services are medically necessary. On a signed plan, click Attest Medical Necessity; the plan then shows the attestation date. See Medicare therapy threshold.

Recertify a plan#

When a signed plan nears its end, write a recertification for the next period:

1. On the Plans of care tab, click New Recertification.
2. Choose the episode and create the draft.

The recertification starts the day after the episode's latest signed plan ends and carries over its frequency, duration, session length, authorization and every goal not yet met or discontinued. Review the goals and terms, then sign it.

Recertify by day 80 of the plan or 10 days before it ends, whichever comes first (the discipline's module settings can change both). The Recertify by date shows on the plan, and the provider's due items on the schedule list it from that day. A plan no physician certifies, such as an ABA treatment plan, has no recertification and shows no Recertify by date. Its Certification column reads Not required, and it never shows as missing a physician signature on the patient's overview, in Oversight or in the certification queue.

The plan of care gate#

NeatPractice checks the plan of care for every daily note and visit:

• New daily notes stop once the plan has ended or used its visits. Starting a daily note dated after the end of the episode's latest signed plan, or past its visit limit, is refused until a recertification covering the date is signed.
• Without any signed plan yet (for example, around the evaluation), NeatPractice only warns.
• Visits are never blocked. The visit window shows a warning when no active plan covers its date of service.
• Progress reports, re-evaluations, recertifications and discharge summaries are always allowed. Medicare's separate progress report rule is described in Progress reports and discharge summaries.

Users who can override documentation gates, such as clinic admins, see a Reason to write it without an active plan field when a daily note is refused. Enter the reason and click Create Draft again; the reason is kept with the note for review.