IEP Coverage and Billing Basics · IEP SERVICES Jenny Roth, IEP Services Coordinator (651) 431-2622...
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IEP Coverage and Billing Basics 4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 1
Transcript of IEP Coverage and Billing Basics · IEP SERVICES Jenny Roth, IEP Services Coordinator (651) 431-2622...
IEP Coverage and Billing Basics
4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 1
Agenda
• Welcome and Introductions
• Results: District Revenue and Billing by Type of Service
• Online Resources
• IEP homepage
• IEP manual
• Basics for all IEP Services
• Specific IEP Services
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Purpose
The purpose of this training is to familiarize those that are new or need a refresher about billing Minnesota Medicaid for IEP health related service.
This presentation will provide guidance on where to find information, what services are reimbursable and what documentation is required.
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Department of Human Services (DHS) Staff
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MHCP Provider - IEP SERVICES Jenny Roth, IEP Services Coordinator
(651) 431-2622 [email protected]
Jesusa Williams, IEP Services Rates(651) 431-2538 [email protected]
Jeri Boomgaarden, Provider Relations(651) 431-3242 MN-ITS training; [email protected]
Jill Johnson, CTSS (Children’s Mental Health)(651) 431-2333 [email protected]
Minnesota Department of Education (MDE) Staff
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Special Education - Third Party Reimbursement (TPR)Ruth Ellen Luehr, Interagency Education Specialist(651) 582-8403 [email protected]
School FinanceMichael Brooks - EDRS(651) 582-8889 [email protected]
Early LearningKara Tempel, Specialist, 0-2yr – Part C Special Education651-582-8495 [email protected]
Side by Side
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Minnesota Department of Human Services
Minnesota Health Care Programs (MHCP):
MHCP Provider of IEP Services
Schools are MHCP Providers (health care providers) of IEP Services
MED
Minnesota Department of Education
Special Education:
Third Party Reimbursement (TPR)
Schools provide and bill for IEP health-related services
ED
Overview
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Minnesota School District Revenue from Third Party Reimbursement
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2014-15 Percent of School Districts Billing by Type of IEP Health-Related Service
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MHCP Online Resources
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MHCP Enrolled Provider-IEP Homepagewww.dhs.state.mn.us/provider/iep
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Provider News
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Previously Published Provider News Items
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Provider Updates
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Watch for Legislative, MHCP and IEP Updates
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Forms, Checklists, Logs, Reports, Documents & Resources
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Provider Manual
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IEP Services Manualwww.dhs.state.mn.us/main/dhs16_151385#
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Latest Revisions to this Manual
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Return to IEP Services Manual
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Basics for All IEP Providers
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IEP Providers
IEP Providers
• Overview• Eligible Providers • National Provider Identifier (NPI)• MHCP Provider Enrollment Electronic Funds Transfer (EFT)• Provider Information and Resources
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MHCP Eligible Children
MHCP Eligible Children• Overview• Eligible Children• Verifying Eligibility
• Understanding Eligibility Response• Managed Care “Carve out”
• Protections for Families and Children for other MHCP Services• Minnesota Health Care Programs (MHCP)
• Parent consent on MHCP Applications • Parent Notification, Release, Consent
• Locating a District IEP Service Provider• MHCP IEP Services Information for Families Brochure
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MDE Third Party Reimbursement (TPR) webpage
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MDE TPR web link
Parent Consent to Share Records and to Bill
Parent Informed Consent – MDE Special Education TPR website link
Schools must • inform parent of intent to bill• get parent consent to share information and to bill• notify parents of rights:
May decline consent; may stop consent at any timeMay ask for billing records
For public insurance (MHCP – MA and MinnesotaCare):One time consent – lasts until change in amount and type of serviceAnnual Notice of parent rights
For private insurance:Annual active consentAnnual notice of parent rights
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Parent Consent Process: Inform
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1. First Inform: Use MDE Model Notice of Procedural Safeguards or local district form
Parent Consent Process: Request Consent – a
2. Then get Consent (a): Use MDE Model Parent Consent form or local district form… or
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Parent Consent Process: Request Consent - b
or 2. Then Consent (b): Use parent’s MHCP application as signed consent.
• MHCP (Medication Assistance (MA) or MinnesotaCare) application via (MNSURE.org).
• Parents give permission to share information and to bill to providers –including schools.
QUESTIONS: Was the parent INFORMED? Does the parent know he/she CONSENTED?
Was the parent informed before providing consent? (wait a year to bill)
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Parent Consent – Handle with Care
• Family finances are a personal, family matter.
• Public support for family health care is a PRIVATE matter.
• Honor families’ privacy and dignity:
Discuss consent for billing in PRIVATE.
Keep information private – data, records, conversations.
Provide the same services for children whether billing for services or not.
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Covered and Noncovered IEP Health-Related Services
Covered and Noncovered IEP Health-Related Services
• Overview• Covered Services
• Coverage Criteria for All Health-Related Services
• Noncovered Services• Criteria for Providing Services via Telemedicine
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Billing and Authorization Requirements
IEP Billing and Authorization Requirements• Overview• Authorization and Orders• Billing requirements
• ICD Codes• Seek Reimbursement for other payers• Benefits and Limitations • Timely Billing• MHCP Eligible Children with Private Health Insurance• Coordination of Benefits (COB)• Electronic Claim Attachments• IEP Procedure Code, Modifiers and Units• Using a Date Span• Submitting a Claim
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Private Insurers - MDE TPR SharePoint
From MDE TPR webpage, at bottom, find instructions to SharePoint.
CONTENTS: ANNOUNCEMENTS
DOCUMENTS - Shared Documents: Private Insurers statewide denialsData
LISTS: CalendarWhere to find info….
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Rates and Payments
Rates and Payments• Overview• Provider Tax• Cost Based Rates
• Assistive Technology• Special Transportation• All Other Health-Related Services
• Interim Rates and Final Rates• Appeal Final Rates• Reconciling Final Rates – Results• Reporting cost data – Districts Responsibility
• Payments• Administration Fee• Remittance Advice (RA)
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Data Needed to Calculate IEP Cost Based Rates
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School Districts
• Direct Service Time
• Direct Encounters
MDE
• Total Annual Salary (per personnel type code)
• Total Contract Expenses (per personnel type code)
• Full Time Equivalence FTE (per personnel type code)
• District Fringe Benefit %
• District Unrestricted Indirect Cost %
• District Contract Days
• District Daily Hours
Example: Calculation of IEP Rates for Physical Therapy
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EDRS Data:PT Salaries $150,000 PT Contract Exp. 20,000
School District Data: MA Direct Hours 3,218
MA Encounters 2,582
Total FTE 3.5 Contract Days 180Contract Hours 7.50
UFARS Data:Fringe Benefit % - 20% ($150,000 *20%) = $30,000
MDE Data:Unrestricted Indirect Cost % - 0.127
Example: Calculation of IEP Rates Physical Therapy per Day (unit)
MA Rate = ($150,000 + $30,000 + $20,000) = $42.32804(3.5 x 180 x 7.50)
= $ 42.32804 x 3,218 = $136,211.60
= $136,211.60/2,582 = $52.75
= $ 52.75 x 0.127 = $ 6.70
= $ 52.75 + $ 6.70
= $59.45/day4/17/2017 Minnesota Department of Human Services | mn.gov/dhs 36
Record Keeping and Documentation
Record Keeping and Documentation• Overview• Health Service Records
• Assistive Technology Devices• Special Transportation• Personal Care Assistant Services• Occupational Therapy, Physical Therapy and Speech Language Pathology ,
Audiology, Mental Health, Nursing and Interpreter Services
• Service Time and Encounters• Record Retention
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IEP Manual Home Page - IEP Health Related Services
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Assistive Technology (AT) Devices
Assistive Technology (AT) Devices• Overview• Authorization and Orders• Covered Services
• Coverage Criteria• Noncovered Services• Health Records and Documentation• Required Documentation for Electronic Claims Attachments• Billing
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Interpreter Services
Interpreter Services• Overview• Authorization and Orders• Spoken Language Interpreter Services
• Competent Spoken Language Interpreters
• Sign Language Interpreter Services• Qualified Sign Language Interpreters
• Covered Services• Noncovered Services• Health Records and Documentation• Billing
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Mental Health Services
Mental Health Services• Overview
• Eligible Providers• CTSS Certification• Cooperatives and education districts
• Eligible Service Providers• Mental Health Professionals (MHP) – Licensed• Mental Health Practitioners and Behavioral Aids – Unlicensed
• Eligible Recipients
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Mental Health Services (cont.)
Mental Health Services (cont.)• Covered Services
• Assessments and Evaluations• Psychological Testing and Diagnostic Assessments• Children’s Therapeutic Services and Supports (CTSS) Services
• Record Keeping and Documentation• Noncovered Services• Billing• Choices for Billing Diagnostic Assessments and Psychological Testing• Mental Health CTSS Definitions and Acronyms
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Nursing Services
Nursing Services• Overview
• Authorization and Orders: IEP team authorizes health-related services• Medical orders for delegated medical functions
• independent nursing functions
• Qualified Service Providers• Professional Nurses – RN, RN/Public Health Nurse, RN/Licensed School
Nurse • Practical Nurses – LPN
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Nursing Services (cont.)
Nursing Services (cont.)• Covered Services - Nurse Practice Act
• Nursing assessment – Evaluation, ongoing assessment• Medication management • Activities of Daily Living
• Noncovered ServicesRoutine health services provided to all others: first aid, antibioticsSupervision of LPN, PCA
• Health Records and Documentation• Billing
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Occupational Therapy Services
Occupational Therapy Services• Overview• Authorization• Qualified Service Providers
• Supervision and Direction of an OTA• Covered Services• Noncovered Services• Health Records and Documentation• Billing
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Personal Care Assistance Services
Personal Care Assistance (PCA) Services• Overview• Eligible Providers
• People Eligible to Provide PCA• Required Training
• Scope of PCA Services• Eligible Recipients• Covered Services
• Activities of Daily Living (ADL’s)• Level 1 Behaviors• Other Health-related Procedures and Tasks
• Noncovered Services
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Personal Care Assistance Services (cont.)
Personal Care Assistance Services (cont.)• Documentation• Activities Checklist• Supervisions
• QP Qualifications• QP Duties
• PCA Plan of Care• Evaluation of the Person Providing PCA Services
• Initial Evaluation• Periodic Evaluations • Documentation of Evaluations
• Record Keeping and Documentation• Billing
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Physical Therapy Services
Physical Therapy Services• Overview• Authorization• Qualified Service Providers
• Supervision and Direction of a PTA• Covered Services• Noncovered Services• Health Records and Documentation• Billing
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Special Transportation Services
Special Transportation Services• Overview• Authorization• Eligible Service Providers• Eligible Children• Covered Services• Health Records and Documentation • Noncovered Services• Billing
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IEP Transportation Rates
• In FY 2010 MDE began calculating “trip rates” for each school district based upon the actual expenditures reported to MDE through UFARS Finance 723
• The total transportation expenditures reported in Finance 723 (salaries of drivers only, fringe benefits, gas, oil, insurance, maintenance) are divided by the number of days that students with special education transportation required by the IEP (MARSS Transportation Category 3) to get a daily rate, divided by two to get a trip rate (to and from school.)
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IEP Transportation Rates Formula
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SpEd Trans. ExpSpEd Mem Days
= Daily Rate 2
= Trip Rate
Trip Rate x District’s Unrestricted Indirect Cost Percentage
= Indirect Costs
Trip Rate + Indirect Costs = Special Transportation Rate per Trip
IEP Transportation Rate Example
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$2,468,595 23,902.55
= $103.28 2
= $51.64
$51.64 x 0.115% = $ 5.94
$51.64 + $5.94 = $57.58 Special Transportation Rate per Trip
Speech Language Pathology and Audiology Services
Speech Language Pathology and Audiology Services• Overview• Authorization Requirements• Qualified Service Providers• Covered Services• Noncovered Services • Health Records and Documentation• Billing
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DHS Contacts
Contacts:
Provider Call Center: Select option 3, 651-437-2700
Jeri Boomgaarden: MN-ITS Provider Trainer, 651-431-3242
Jesusa Williams: IEP Rates and payment Consultant, 651-431-2538
Jill Johnson: Children's Mental Health Consultant, 651-431-2333
Jenny Roth: DHS IEP Coordinator, 651-431-2622
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MDE Contacts
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Special Education - Third Party Reimbursement (TPR)Ruth Ellen Luehr, Interagency Education Specialist(651) 582-8403 [email protected]
School FinanceMichael Brooks - EDRS(651) 582-8889 [email protected]
Early LearningKara Tempel, Specialist, 0-2yr – Part C Special Education651-582-8495 [email protected]
Questions?
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IEP SERVICES
Thank you!
