Medicaid Billing Module Personal Care Services Billing Form.

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 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

[email protected] ext 53223

WVDE Medicaid Website:http://wvde.state.wv.us/osp/medicaid.html

mailto:[email protected]

http://wvde.state.wv.us/osp/medicaid.html

http://wvde.state.wv.us/osp/medicaid.html

Medicaid Billing Module Personal Care Services Billing Form.

Documents

Transcript of Medicaid Billing Module Personal Care Services Billing Form.