CPR+ has added functionality in version 8.1 that will track quantity limits per payor on a daily or monthly usage basis. These quantity limits are set in the Special Price Matrix. This feature allows the user to set a quantity override, per patient, through the creation of an authorization record. As an example; Medicaid limits mic-key buttons to 2 per month. This limit would be set in the SPM for Medicaid and if the item is on a delivery ticket that has a date range within a month's time of the new DT, a quantity overage warning would be given.

In the Special Price Matrix locate the “Limit” and “Freq.” fields on the Pricing & Formulation tab of the appropriate inventory item.

The limit is set as a numeric value that is in accord with the indicated frequency: either monthly “M” or daily “D”. The “Limit” field is a numeric field that is the number of items permitted – meaning the actual quantity limit as defined by the contract. In entering values for these items, you’ll want to keep in mind a few things:

• The “Monthly” Freq. is based only on the From date on the Delivery Ticket
• The “Daily” Freq. is based on the From and To dates on the Delivery Ticket.
• Enteral formula is tracked by the number of cans, not calories or milliliters, because this tracking is done based on the Delivery Ticket quantity dispensed.
• The tracked quantity of any item is HCPC specific so if there are multiple items in inventory with the same HCPC, you need only enter the quantity on one item.

On the Working Delivery Ticket, CPR+ checks the items, and if any have limits that have been reached. This is calculated by looking at all tickets for that HCPC, for the patient, confirmed and unconfirmed, summing up the quantities used for the "period" based on the ticket's FROM date and including the quantity on the current working ticket. This check is done anytime the ticket is opened, a quantity changes (in the grid), or an item is added to the ticket. ALL items on the ticket are checked when the ticket is opened.

The Monthly limit counts by calendar month (01/01/09-01/31/09). This means that CPR+ will evaluate quantity overages based on any Delivery Ticket, confirmed or not, that falls within the calendar month. We sent two mic-key buttons to the patient on January 2nd. Any Delivery Ticket created for the patient containing an additional quantity of mic-key buttons with a From date within the month of January would cause an overage message to be displayed.

CPR+ gives them a message showing the items that have had their limits reached, what the limit is, what the period is, and what they currently have dispensed (including the quantity on the current ticket).

The Daily limit counts by the number of days represented by the From and To dates of the Delivery Ticket. This means that if you are sending out a 7-day supply, then CPR+ looks at the quantity entered in the Special Price Matrix and multiplies it by the number of days represented by the ticket's days to reach a final allowable quantity.

Now that you know how the basic setup works, let’s look at overriding the quantity on a patient-by-patient basis. CPR+ allows for a quantity override to be accomplished by creating an authorization for the item in the Insurance Verification for the patient.

As you can see, there are now Limit and Freq. fields on the Authorization Setup Screen. These fields will supersede the information found for the item in the Special Price Matrix, thus creating a patient-specific limitation. When the user returns to the Working Delivery Ticket and pulls the item on, the new limit that was set on the authorization and the limit that was set in the Special Price Matrix is ignored.

Note that the quantity limit override is only applicable for the dates entered on the authorization. If the dates on the Delivery Ticket do not fall in the date range of the authorization, CPR+ reverts to the quantity limit set in the Special Price Matrix.

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One of CPR+’s most flexible clinical reports is the Active Orders report – maybe that’s why it’s #1 on the Clinical Reports Menu. To run the report, from the Main Menu, select Reports (4) > Clinical Reports (1) > Active Orders Report (1). You will be prompted to select the type of orders you want to view – Drug, HME or both, and Primary, Ancillary or Both. You can also select a single Therapy Type if you like. 

The report shows you the patient information, the assigned payor, and the ordering physician, grouped by Therapy Type, for all orders in CPR+ that are currently active, based on the criteria you selected. All orders on this report have a status of “Active,” even if they have a Stop Date in the past. You may not be dispensing the drugs, but they are listed as Active in the Patient’s Medication Profile.

The report can show you therapeutic duplications, which lines of business have the most activity, and which physicians are sending you which kind of customers. A summary report shows total active order counts by Therapy Type.  Run this report weekly to see where your business is growing.

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