Post on 30-Dec-2015
Medicaid Billing Module
Personal Care Services
Billing Form
Changes to Personal Care Billing
• Personal Care will now be billed in 15-minute units.
• Maximum of 28 units per instructional day.• Units must be documented with start and
stop times.• Extra minutes can be carried over to the
next instructional day.
Personal Care Changes
• Billing form is a daily form per student.• Form is two pages long.• Personal Care Provider will be required to
document start and stop times for each billable service throughout the school day.
Student Demographics Section
Medicaid Number
Last Name First Name County School Procedure Code
T1019 SE
WVEIS # Diagnosis Code Date of Birth Month/Year Provider Name (Printed)
Personal Care must be identified on the Service PlanDATE OF SERVICE: ______________________________
Student Demographics Section• On the top row enter the information as requested. County
and school as the code numbers• On the second row enter data as requested.• Suggest printing a copy with all demographics completed
except month/year. This will serve as a template for the school year.
• Print the name of the employee providing the personal care services.
• If two employees split the tasks with one student, each employee would complete a separate form for the services they provided.
Student Demographics Section Example
Medicaid Number
Last Name First Name County School Procedure Code
0000000001 Doe Jane 058 303 T1019 SE
WVEIS # Diagnosis Code Date of Birth Month/Year Provider Name (Printed)999999999 01-01-1900 August, 2015 John Smith
Personal Care must be identified on the Service PlanDATE OF SERVICE: ______________________________
Date of Service
• List the date the services were performed. • List the same date on the second page.• List the student’s name on the second
page.
Data Entry Section
• This is divided into 5 categories of personal care activities.
• Total of 25 billable activities• Minutes from all of the activities are
combined to determine the number of units for the day.
Data Entry Section
• There is space for six start and stop times for each activity.
• If an activity occurs more than six times a day, add additional pages as needed.
• Document the start and stop times as soon as possible when the activities occur.
• Documenting quickly will ensure more accurate data.• If a specific activity does not occur, leave those
spaces blank.
Data Entry Self Help Skills
CATEGORY/ACTIVITYSTART/END TIMES FOR EACH ACTIVITY
For each time an activity is provided list the start and end time. If more than six in one activity use an additional form
MINUTES
Self Help Skills Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time
A. Grooming 8:00 | 8:10 | 1:00 | 1:10 | | | | | | | |
20
B. Bathing | | | | | | | | | | |
C. Toileting 9:05 | 9:15 | 2:13 | 2:25 | | | | | | | |
22
D. Dressing | | | | | | | | | | |
E. Laundry (Employee Doing) | | | | | | | | | | |
F. Brushing Teeth 12:10 | 12:15 | | | | | | | | | |
5
G. Hand Washing 9:15 | 9:20 | 11:05 | 11:10 | 2:25 | 2:30 | | | | | |
15
Data Entry Non-Tech Physical Assistance
Non-Tech Physical Assistance Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time MINUTES
A. Repositioning/Transfer
| | | | | | | | | | |
B. Walking | | | | | | | | | | |
C. Medical Equipment (Adaptive)
| | | | | | | | | | |
D. Assistance with Medication
| | | | | | | | | | |
E. Range of Motion (ROM) (Per Phys. Order)
| | | | | | | | | | |
F. Vitals (Per Phys. Order)
| | | | | | | | | | |
G. Catheterization | | | | | | | | | | |
H. Communication | | | | | | | | | | |
Data Entry Nutritional Support
CATEGORY/ACTIVITY
START/END TIMES FOR EACH ACTIVITYFor each time an activity is provided list the start and end time. If more than six in one activity use an additional form
MINUTES
Nutritional Support Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time
A. Meal Preparation
| | | | | | | | | | |
B. Feeding
| | | | | | | | | | |
C. Special Dietary Needs
| | | | | | | | | | |
Data Entry Environmental
Environmental Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time MINUTES
A. Housecleaning | | | | | | | | | | |
B. Laundry/Ironing (Supervision)
| | | | | | | | | | |
C. Making/Changing Bed
| | | | | | | | | | |
D. Dishwashing
| | | | | | | | | | |
Data Entry Behavior Modifications
Behavior Modifications
Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time | Start Time | End Time MINUTES
A. Supervision of Non-Educational Time
7:45 | 8:00 | 11:10 | 12:10 | | | | | | | | 90
B. Redirection
9:30 | 9:40 | 9:55 | 10:00 | 1:15 | 1:20 | 1:30 | 1:39 | 1:50 | 1:55 | | 34
C. Positive Behavior Supports
1:55 | 2:15 | | | | | | | | | | 20
Data Entry Minutes• Add up the total minutes per row and list in the Minutes
column at the far right of the pages.• If an activity does not have any start and stop times
listed, place NA in the minute column for that row.• In the carryover box enter any extra minutes from the
previous day. The first day would be zero minutes. This carryover would be added to the minutes for the total minutes for the day.
• Add up the minutes from both pages and the carryover minutes. List under total minutes.
Unit Calculations
CARRYOVER MINUTES FROM PREVIOUS INSTRUCTIONAL DAY 0
Unit Calculations
TOTAL DAILY MINUTES 206 DIVIDE BY 15 = TOTAL DAILY UNITS 13 Carryover minutes for next instructional day 11
Calculations
• There were not any carryover minutes in our example.
• Total 206 minutes• Divided by 15 minutes• Equals 13 units• Remainder of 11 minutes that will be entered
into the carryover box on the next day’s data entry form.
Signature and Credential
• The provider signs the form• The provider lists credential• Credential is the employee designation
such as Aide (I, II, III, IV), Autism Mentor, Paraprofessional, ECCAT(I,II,III), Braille Specialist, Sign Language Interpreter(I, II), Sign Support Specialist, or LPN.
Terry Riley – CoordinatorOffice of Special Education
tjriley@k12.wv.us304-957-9833 ext 53223
WVDE Medicaid Website:http://wvde.state.wv.us/osp/medicaid.html