Session-Based Care/Shared Care

Session-Based Care (also known as Shared Care, group service, enclave, or crew) is a model of care where a Caregiver is assigned to oversee a group of individuals rather than providing individual care. The Caregiver either starts services for 2 or more Clients at the same time, or the caregiver staggers the start time for Clients (such as in employment services when a job coach might pick up clients from their homes and take them to a job site).

In this topic, we'll review the steps needed to successfully set up and provide Session-Based Care.

To set up a Caregiver for Session-Based Care:

  1. All Clients must have a Care Period, Service Agreement, and Care Delivery set up. Clients must also have the Caregiver on their Care Team.

  2. Set up a payrate for the Caregiver with the appropriate Allocation Ratio for the session.

  3. Make sure that the Caregiver has a payrate for reimbursements, if allowed.

To begin a session:

  1. Add a session from the Pavillio Caregiver App.

  2. Caregivers can request a reimbursement during the Visit.

  3. At the end of the session, have the Client/Responsible Party approve the session.

After the session has been completed:

  1. Review reimbursements via Care Management > Approve Visits > Reimbursement.

  2. Go to the Timecards tab, review the Visit records, and Finalize them. This automatically finalizes reimbursements as well.

    If changes need to be made after the session is finalized, the entire session must be deleted and reentered.

    • All finalized visit time and reimbursements go to Financials > Generate Payroll to be computed for the payroll export as reimbursements. Reimbursements are NOT billable.

    • All finalized session records go through validations before going to Financials > Claims Management > Process Claims tab for sending to the Payor.

There are two billing type parameters for sessions: Actual and Shared. Actual is the total visit time clocked for each client and is billed at the applicable ratio/service code based on the number of clients in the session. Shared is the total visit time divided by each client in attendance. The configuration selected applies for all sessions submitted and billed at the agency.

Actual Example: A Caregiver starts a PCA session with 2 Clients and works 30 minutes. Then, a third Client is added for another 30 minutes. When the records go through system validation, the first 30 minutes (2 units) is T1019.TT and the last 30 (2 units) is T1019.HQ.

Shared Example: A Caregiver starts a session with 3 Clients. The Clients work for 3 hours before the session is ended. With shared billing configuration, the time is split equally between these three clients- 1 hour (4 units) per client for that date of service.