HEALTH RELATED & IEP SERVICE COORDINATION MEDICAID BILLING ... · PDF fileIEP SERVICE...

Prince George's County Public Schools

HEALTH RELATED &

IEP SERVICE COORDINATION

MEDICAID BILLING MANUAL SY 2015-2016

Prince George's County Public Schools

Medicaid Recovery Office

14201 School Lane, Temp # C05-451

Upper Marlboro, MD 20772

301- 952-6349 Phone ▪ 301-780-5925 Fax

http://www1.pgcps.org/medicaid

HEALTH RELATED & IEP SERVICE COORDINATION MEDICAID BILLING MANUAL

SY 2015-2016

Contents INTRODUCTION & OVERVIEW ............................................................................................... 1

Program Background & Description ....................................................................................... 1

Program Mission .................................................................................................................... 1

Our Values ............................................................................................................................. 1

Program Goals ....................................................................................................................... 1

Overview of Eligibility Requirements ...................................................................................... 2

Other Requirements ............................................................................................................... 2

IEP SERVICE COORDINATION ............................................................................................... 3

Certification / Licensure Requirements .................................................................................. 3

What Is Service Coordination? ............................................................................................... 3

What TYPES OF Services Are Billable For Medicaid?........................................................... 3

Description of IEP Service Coordination TYPES ................................................................... 3

MEDICAID BILLING PROCESS & RESPONSIBILITIES ........................................................... 6

Medicaid Office - Internal Process ......................................................................................... 6

Principal’s Responsibilities ..................................................................................................... 6

Special Education Coordinator’s Responsibilities .................................................................. 7

Medicaid Coordinator’s Responsibilities................................................................................. 7

Case Manager / IEP Service Coordinator Responsibilities .................................................... 7

Managing Parental Consent ................................................................................................... 7

Managing Case Manager/IEP Service Coordinator Notification ............................................. 8

Medicaid Record Retention .................................................................................................... 9

Documentation Requirements - IEP Coordination ................................................................. 9

HEALTH RELATED SERVICES .............................................................................................. 13

Overview of Health Related Medicaid Billing Requirements ................................................. 13

Health Related Provider Responsibility ................................................................................ 13

Important Points To Remember ........................................................................................... 14

SPEECH/LANGUAGE SERVICES .......................................................................................... 15

Speech/Language Credentials ............................................................................................. 15

Revised 7/2015 Medicaid Billing Manual SY 15-16 ii | P a g e

Speech/Language Assessments .......................................................................................... 16

Documentation Examples for Speech/Language Services .................................................. 16

PSYCHOLOGICAL SERVICES ............................................................................................... 18

Psychological Services Reimbursable By Medicaid ............................................................. 18

Psychological Services Provider Credentials ........................................................................ 18

Entering Medicaid Service Logs ........................................................................................... 18

OCCUPATIONAL & PHYSICAL THERAPY SERVICES .......................................................... 19

Billable Occupational & Physical Therapy Services ............................................................... 19

Occupational & Physical Therapy Provider Credentials ........................................................ 19

Entering Medicaid Service Logs ........................................................................................... 19

AUDIT REQUIREMENTS ........................................................................................................ 23

FRAUD & FALSE CLAIMS STATEMENT ................................................................................ 24

INCENTIVE FUNDS ................................................................................................................ 27

FREQUENTLY ASKED QUESTIONS (FAQS) ........................................................................ 30

Revised 7/2015 Medicaid Billing Manual SY 15-16 1 | P a g e

INTRODUCTION & OVERVIEW PROGRAM BACKGROUND & DESCRIPTION

Since 1994, the Prince George’s County Public School (PGCPS) System has participated in a Federal health insurance program called Medicaid. The program assists school districts by providing reimbursement for medically-related services listed on a student’s Individualized Education Program (IEP). Although this reimbursement is available only for students who are Medicaid eligible, services are provided to ALL students with special needs regardless of their Medicaid eligibility status. The Medicaid Recovery Office (MRO) within Business Operations (Office of the CFO) and in collaboration with the Office of Special Education is tasked with maximizing recovery of the Medicaid funds. The school district can bill Medicaid for case management and health related services identified in a student's Individualized Education Program (IEP). These services include speech/language therapy, occupational therapy, physical therapy, nursing, social work, psychological services and health-related evaluations. Currently, there are over 8,530 Medicaid eligible students with special needs in the Prince George's County Public School system. These students constitute 53% of the special education population and 7% of all students attending Prince George’s County Public Schools. PROGRAM MISSION

We support student achievement by maximizing the recovery of Medicaid funds through collaborative relationships within the school district’s community. OUR VALUES

We agree to always operate with high integrity; show respect for each other’s ideas and feelings; hold each other accountable for performing with excellence; and always communicate clearly and concisely with each other and our stakeholders. PROGRAM GOALS

o To operate with integrity, excellence and professionalism and to provide quality

service that is effective, efficient and accountable to all stakeholders;

o To increase and maximize efforts to recover Medicaid funds in order to enhance

services provided to PGCPS students with special needs;

o To improve efforts in order to meet regulatory compliance in accessing Medicaid

reimbursement funds;

o To increase children and youth’s access to comprehensive health services

through the PGCPS school-based Medicaid reimbursement program;


o To increase collaboration among schools, families, and state agencies, where

each partner has a defined role and demonstrates commitment and accountability

to the students with special needs of PGCPS;

o To develop and implement a long-range plan for helping to ensure sustainability

of a comprehensive Medicaid reimbursement program.

OVERVIEW OF ELIGIBILITY REQUIREMENTS

In order for PGCPS to receive Medicaid reimbursement, the services billed must be: o Provided to a Medicaid eligible student under the age of 21

o Provided to a student with an active IEP

o Provided by a qualified practitioner (possess proper licensure/certification)

o Medically necessary and address a student’s disability

o Consistent with the intent of the IEP identified services and planned goals

o Documented to support that the services billed relate directly to the IEP

OTHER REQUIREMENTS

Parental Consent – Federal regulations (34 CFR 300.154(d)) require PGCPS to obtain written consent from the parent before billing Medicaid. PGCPS does this through the Medicaid Parental Consent form or the MA Authorization page from the IEP which is required for each student with the parent’s signature. Parental Notification – On February 14, 2013, Federal regulations were revised to require PGCPS to provide written notification to each parent prior to the parent’s consent and annually thereafter. This notification explains all of the protections available to parents under Part B, as described in 34 CFR 300.154(d)(2)(v) to ensure parents are fully aware of their rights. Case Manager/IEP Service Coordinator Notification - State of Maryland regulations (COMAR 10.09.52.03) require PGCPS to provide notification, as well as, obtain approval from the parent regarding the student’s assigned case manager/service coordinator and the parent’s acceptance of coordination services related to the IEP. The Case Manager Notification form documents the parent’s approval and must be renewed for each change in case manager /IEP service coordinator during the school year.


IEP SERVICE COORDINATION CERTIFICATION / LICENSURE REQUIREMENTS

In order to submit billing for IEP service coordination, the service provider must be: o A professional who has a current license or certification in accordance with

COMAR 10.09.52.03(C)(2)(3):

Audiologist, registered nurse, occupational therapist, physical therapist, social

worker, or speech-language pathologist licensed in the State of Maryland; OR

Guidance counselor, pupil personnel worker, speech-language pathologist,

psychologist with at least a master’s degree; OR

An educator with a MSDE issued teaching certificate (Advanced Professional

Certificate, Standard Professional Certificate or a Conditional 2-year

Certificate).

o Others may serve as service coordinators under COMAR 10.09.52.03(C)(2)(4)

but with restrictions.

WHAT IS SERVICE COORDINATION?

Service Coordination is defined as “case management services” that assist students in gaining access to the services identified in his/her Individualized Education Program (IEP). The case manager monitors the delivery of the student’s goals and objectives and ensures that they meet the student’s current needs. It is a continuum of services provided during the month. The case manager also participates with the IEP team in the development and/or review of the student’s IEP. WHAT TYPES OF SERVICES ARE BILLABLE FOR MEDICAID?

Development of the Initial IEP

Periodic IEP Review

On-Going Service Coordination

DESCRIPTION OF IEP SERVICE COORDINATION TYPES

Initial IEP This service consists of convening and conducting an IEP team meeting to perform a multi-disciplinary assessment, which results in the development of an initial IEP for a student. This service is billed once in the lifetime of the student. The following forms are needed:

Copy of the Parental Consent form (or “Medical Assistance Authorization” page of the IEP)

Copy of the Sign-In Sheet from the IEP meeting with parent’s signature indicating their

attendance


Copy of the Case Manager Notification form

You should use the “Initial IEP” service type when recording the service log in Compuclaim.

Periodic IEP Review This service consists of convening and conducting an IEP team meeting (other than the initial IEP meeting) to review the student’s progress towards IEP goals. This may result in a revised IEP. The team performs a multidisciplinary re-assessment of the student's IEP status and service needs. No more than three (3) IEP reviews can be billed to Medicaid within a 12-month period. If the student’s IEP was not revised, the case manager should document participation of at least two different disciplines within the IEP team meeting. If the parent did not physically attend the meeting or only participated by telephone, please indicate this under the “Comment Section” of the Compuclaim service log:

The parent did not attend the meeting but was notified of the meeting and was mailed results of the meeting on…….

The date of the IEP Meeting and the date of the service log in Compuclaim must match.

Please use “Periodic IEP Review” service type for Compuclaim.

Please note: Manifestation, School Instructional Team (SIT) or other disciplinary meetings are not billable. On-going Service Coordination This service consists of activities throughout the month by the case manager to assist students in gaining access to the services indicated in his/her IEP. The following IEP service coordination activities are billable only if included in a documented discussion or progress note to the parent regarding IEP progress:

Acting as a central point of contact relating to IEP services for the student.

Maintaining contact with the student’s direct service providers or student’s

parent/guardian through home visits, progress notes, etc. regarding IEP

Implementing the IEP by referring the student to direct service providers.

Assisting the student in gaining access to services specified in the IEP.


Discussing with direct service providers the services needed and available for

the student.

Assessing the quality and quantity of services being provided.

Following up to identify any obstacles to a students’ utilization of services.

Coordinating the service delivery.

Performing ongoing monitoring to determine whether the services are being

delivered in an integrated fashion as recommended on the IEP, and meet the

student’s current needs.

Providing a student and the student’s parent with information and direction that

will assist them in successfully accessing and using the services indicated in

the IEP.

Informing the student’s parent of the student’s rights and responsibilities in

regard to specific programs and resources recommended in the IEP.

DOCUMENTING IEP SERVICE COORDINATION

Case Managers/IEP Service Coordinators will document at least one contact per month in the Compuclaim program. This contact will be in the form of an IEP Monthly Progress Note, created in Compuclaim, to the parent regarding the student's progress pertaining to their IEP goals and objectives. The contact from the IEP Service Coordinator can be:

in person,

by telephone, or

a written progress note or log.

Case Managers/IEP Service Coordinators should also include comments regarding progress about a health related service if applicable. Communication can be with the student (if they are over 6 years of age) or the parent/legal guardian. Please use “Ongoing Service” service type for Compuclaim.


MEDICAID BILLING PROCESS & RESPONSIBILITIES

MEDICAID OFFICE - INTERNAL PROCESS

The Medicaid Office’s internal process begins with the identification of Medicaid eligible students with special needs. Identification of this population is generally achieved in two ways:

Conducting a data match with the State of Maryland Department of Health and

Mental Hygiene (DHMH); and

Cross-matching Medicaid participating students with those who have an IEP

identifying them as students with special needs.

The Medicaid Office compiles student lists (Medicaid eligible students with an active IEP) for each school and communicates this list via the Compuclaim Service Portal. Each case manager is able to create his/her own caseload within the Service Portal. On a monthly basis, the case managers and other service providers complete the service logs in the web-based Service Portal. If necessary, appropriate documentation should be forwarded to the Medicaid Office. Prior to billing, the Medicaid office ensures each claim meets the minimum requirements such as parental notification of case manager, parental consent, adequate case manager qualifications, and student’s Medicaid eligibility. Once claims are verified, the Medicaid Office submits the claims to DHMH for reimbursement on a weekly basis. Payments are received via wire transfer and are recorded into the appropriate Medicaid fund within the Oracle financial system. PRINCIPAL’S RESPONSIBILITIES

Principals are responsible for the following tasks:

Enforcing Medicaid policies and procedures throughout your school.

Ensuring Medicaid services billing claims are completed and submitted by the 5th

of the following month.

Ensuring a Medicaid Coordinator is assigned for your school.

Checking the Service Portal, specifically the Performance Report, to determine

your school’s submissions and status of Medicaid claims.

Consulting with your Medicaid Coordinator about outstanding claims and parental

consents.


SPECIAL EDUCATION COORDINATOR’S RESPONSIBILITIES

Special Education Coordinators are responsible for the following tasks:

Identifying a Medicaid Coordinator in your school.

Implementing and communicating Medicaid policies and procedures throughout

your school.

MEDICAID COORDINATOR’S RESPONSIBILITIES

Medicaid Coordinators are responsible for the following tasks:

Reviewing each Case Manager’s caseload list via the Compuclaim Performance

Report. All special education students should be assigned a case manager.

Ensuring all service logs for each Medicaid eligible student are adequately

documented and entered into Compuclaim by the 5th of the subsequent month.

Collaborating with Case Manager(s) to resolve any outstanding Parental Consent.

Obtaining Case Manager/IEP Service Coordinator Notification forms.

Facilitating timely changes to SchoolMax and Maryland Online IEP (MDIEP) to

reflect new students and/or changes in student status.

CASE MANAGER / IEP SERVICE COORDINATOR RESPONSIBILITIES

Case Managers/IEP Service Coordinators are responsible for the following tasks:

Obtaining outstanding parental consent(s)

Completing Case Manager/IEP Service Coordinator Notification form and

forwarding to Medicaid Coordinator

Submitting IEP Service logs by the 5th of the following month in the Compuclaim

Service Log by Student Wizard. One claim is needed per month:

o Conducting IEP Team Meetings (preferred), or

o Sending Quarterly IEP Progress Reports to Parents, or

o Signing and mailing a copy of the IEP Monthly Progress Note to the parent

in subsequent months

Updating MDIEP for any changes in the student's IEP status

MANAGING PARENTAL CONSENT

As of February 14, 2013, Federal regulations (34 CFR 300.154(d)) require PGCPS to obtain a one-time written consent (or Parent Permission) form for each student prior to billing Medicaid. The consent specifies the student’s information disclosed to the State of Maryland’s Department of Health and Human Services (DHHS) for Medicaid billing


purposes as well as the parent’s understanding and agreement to allow PGCPS to access their medical assistance benefits to pay for services. The Medicaid Coordinator’s responsibility is to obtain the written parental consent for each student. This consent may be obtained in two ways:

Medicaid Parental Consent Form, signed by the parent (maintain original in LAF

folder); or

Medical Assistance Authorization page of the IEP, signed by the parent

The latest version of the Medicaid Parental Consent Form in both English and Spanish can be located on our website http://www1.pgcps.org/medicaid. The Medicaid Office will inform schools of any students with outstanding parent consents. The forms should then be scanned and emailed to [email protected]. MANAGING CASE MANAGER/IEP SERVICE COORDINATOR NOTIFICATION

Each month, the Medicaid Office will communicate to the Coordinator those students who do not have a case management notification form on file. The Medicaid Coordinator should obtain the forms from the Case Managers. The forms should then be scanned and emailed to [email protected]. An updated Case Manager/IEP Service Coordinator notification form is required anytime the case manager changes. The notification form for the newly assigned case manager should be forwarded to the Medicaid Office and the original mailed to the student’s parent / guardian. A template of the case manager notification letter is available on the Medicaid Office website http://www1.pgcps.org/medicaid. Typically, the Medicaid Office facilitates schools in pre-printing the initial case manager notification letters. The assigned case manager should print, sign the letter, and make a copy:

Original letter mailed to the parent / guardian

Copy filed in the student’s LAF folder

Immediately scan and email copy to Medicaid Office at [email protected]

The case manager notification letter provides the parent the option to return a signed copy of the letter to the school within fifteen (15) days. In the instance these forms are received from the parent, a copy should be sent to the Medicaid Office and a second copy maintained in the student’s LAF folder. DHMH recommends letters be sent to parents of all students with special needs regardless of current Medicaid eligibility status.


COMPLETING AND SUBMITTING IEP SERVICE CLAIMS

Medicaid billing claims are required to be completed for each school by the 5

th

of

the following month in the Compuclaim Service Portal:

www.meduclaim.com/serviceportal

You are required to complete the Medicaid billing claim service log for every Medicaid eligible student. If there were no billable services for the month you should still complete the service log as Non-Billable and indicate the reason in the comments section. Some non-billable instances include:

Student transferred to another school within PGCPS or out of the school district

Student has graduated

Student no longer has an active IEP

Please refer to the Medicaid Service Portal Handbook for instructions on completing Medicaid service logs in Compuclaim.

MEDICAID RECORD RETENTION

Case Managers should make copies of any progress notes mailed to parents and file in the student’s Limited Access File (LAF). Medicaid documentation must be maintained for a minimum of six (6) years. DOCUMENTATION REQUIREMENTS - IEP COORDINATION

Periodic IEP Review When entering an IEP Meeting service log in Compuclaim, the following dates should match: o Date of IEP Team Meeting on the Sign-In Sheet

o Notice of IEP Team Meeting date

o Meeting date noted on the Prior Written Notice

In the Comment Section of the service log, you are required to enter whether the parent attended and the general outcome of the meeting. IEP Quarterly Progress Report

You can bill for submitting the IEP Quarterly Progress Report to the student’s parent/guardian. The service date in the Compuclaim service log should match the date of the progress report. Also, in the Comment Section of the service log you should type:

“IEP Quarterly Progress Report was sent to parent.”


There is no need to send us a copy, as it can be accessed from MDIEP, if required for audit purposes. Monthly IEP Progress Note Written documentation is used to support any method of communication with the parent/legal guardian as it relates to the IEP. When completing a Compuclaim service log these are examples of what to write in the Comment Section.

Example 1: Amy has displayed progress toward reaching her IEP goals by completing all assignments willingly, asking for help 90% of the time. She makes predictions and previews the text with relative ease. She uses these skills to help her gain meaning from the text. Amy also has occupational therapy 2 times a week. The occupational therapist has reported that she is making progress on her fine motor skills and therapy goals are appropriate. Example 2: Joyce needs some wait time to recall her multiplication facts from 7-9, but is able to complete this task with 80% accuracy. Continued support is needed to display mastery of her Math IEP goals. I understand that she visited her doctor this month to review and evaluate her medication, but there has been no change in Joyce’s medication.

Example 3: Avery is making very minimal progress towards achieving his math, reading and behavioral IEP goals. He is unable to identify numbers and count to 10. He requires continuous prompting and redirecting in order to achieve his goals. Avery is unable to use flash cards to show each individual sound in a word or to outright spell a CVC word without numerous prompts and redirecting. The speech therapist reports that his progress is slow; they will continue with the current plan of treatment and continue to encourage Avery to recognize blends and sounds.

Telephone Contact When describing a phone call, indicate to whom you spoke, the nature of the call and how it relates to meeting the goals detailed in the student’s IEP. Document the discussion with the parent regarding the student's progress towards mastery of the IEP goal. (Contact must be with parent/guardian only. Voice mail messages cannot be used as a contact type). Here are examples of adequate documentation for the comment section in the IEP Service Log for a telephone contact:

Example 1: “During our phone conversation regarding Brittany’s reading, math and written language progress, we discussed that Brittany’s OT services were begun as prescribed in the revised IEP. Brittany is responding positively to the services and looks forward to the sessions. We will discuss the progress made by next month. ”


Example 2: “This is documentation of the telephone conversation I had with Delmar’s mother. I contacted Delmar’s mother regarding his excessive absenteeism and how it is greatly impacting progress towards the mastery of his IEP goals for this year. He may not be able to make up all the work he has missed to achieve his goals. She has agreed to make sure that he comes to school more consistently and on time by developing a reward system.” We will look at this attendance again every month.

Unacceptable Contacts for Medicaid Billing

Some communications with the parent are not considered billable for Medicaid, such as:

o Field Trip Notices or Flyers

o PTA meetings/Open House or Back to School Notices

o Announcement of resource fairs (for example, for transition planning)

o Requests to parents for items such as: diapers, lunch money or extra clothing.

o Verifying the student’s attendance status without discussing how it relates to the

student’s progress towards their IEP goals and objectives.

Unacceptable Written Documentation

Do not document information or encounters that are unrelated to the student’s progress towards IEP goals and objectives:

Unacceptable: “I spoke to Keila’s mother about her graduation gown. We were concerned if it would fit her. It fits and she looks great. We will be taking pictures today.”

Instead write: “It was a pleasure discussing with you Keila’s upcoming graduation and the requirements that must be met. She has made great progress towards mastery of her IEP goals and is on target to complete all requirements by the deadline.”

Do not document or summarize communication or contact regarding only scheduling IEP meetings:

Unacceptable: “The letter was sent to the parent to set up an IEP meeting. I also called the parent to confirm.”

Instead write: “Prior to the IEP Team Mtg, feel free to contact me if you have further concerns about what you would like addressed at the upcoming IEP Meeting regarding Jeff’s current progress. He has achieved most reading/language objectives on his IEP. He will, however, need to concentrate more on his math goals. His speech therapy will continue as well. Thank you for confirming that you will attend the IEP Team Meeting.”


Health Related Services


HEALTH RELATED SERVICES OVERVIEW OF HEALTH RELATED MEDICAID BILLING REQUIREMENTS

The following are health related services that PGCPS currently provides to some students with special needs:

Speech/Language Therapy

Audiology Services

Nursing Services

Nutrition

Occupational Therapy

Physical Therapy

Psychological Services

PGCPS health related service providers must document all direct services per month as prescribed in the student’s IEP. The following types of services are billable: o Face-to-face direct service

o One-on-one direct assessments/evaluations

o Treatments

The health provider will document each student encounter as usual within Maryland Online IEP (MDIEP). The Medicaid Office will import the MDIEP related logs into the Compuclaim Service Portal weekly. The provider can then validate services within the Compuclaim Service Portal by the 15th of the following month. Please see the Medicaid Service Portal Handbook for instructions on validating the health related service logs. HEALTH RELATED PROVIDER RESPONSIBILITY

o Document each individual session or encounter on the “Related Services Log” in

Maryland Online IEP. Each note must include:

Sessions (for example “session 4 of 5”)

Description and the nature or extent of services provided

Statement about the student’s progress that includes a

measurable outcome

Your name, degree and credentials. (e.g. Michelle Helper, MS,

CCC SLP)

o In order to receive reimbursement for Medicaid billable services (SLP, Psych,

OT, PT) the IEP must contain either a daily, weekly or monthly prescription of

services. (See MSDE Technical Bulletin 21 in August 2010.)


o Ensure billing is consistent with the student’s service description as outlined in

the “Related Services” section of the IEP. You should monitor the session

number on the Monthly Service Record (e.g., Session 1 of 10) to prevent billing

over the number of prescribed services.

o Validate service logs within Compuclaim by the 15th of the following month.

MD ONLINE IEP BILLING DOCUMENTATION

DHMH requires a written description of the intervention provided to the student.

The note should clearly describe the intervention/activity that was provided, and

the student’s response to it. If individual therapy occurs while a provider works

with a student during a class setting, the note needs to clearly specify and

describe the individual treatment provided to the student.

IMPORTANT POINTS TO REMEMBER

o Yearly and quarterly frequencies are no longer accepted for Medicaid billing

purposes.

o Billable services are listed on the IEP Services page as a related service.

o Do not bill for consultations with members of the IEP Team or other adults.

o If the session was a make-up, denote “M/U” in the MD Online service log and

indicate the date of the missed session in the Description of Service area. (For

example “M/U for 11/10/15”)

o Remember, Medicaid can bill for make-up sessions that do not occur on the

same day as therapy. If, however, the make-up session is the same day as

therapy, you may mark that session Individual or Group therapy in MDIEP; in

Compuclaim, select non-billable as the service type.

Revised 7/2014 15 | P a g e Medicaid Billing Manual SY 14-15

SPEECH/LANGUAGE SERVICES

The following Speech/Language services are reimbursable by Medicaid:

Procedure Code Description

92521 Evaluation of Speech fluency

92522 Evaluation of Speech sound production

92523 Evaluation of Speech sound production with evaluation of language comprehension and expression

92524 Behavioral and qualitative analysis of voice and resonance

92523 w/ 52 modifier Language only evaluation

92507 Individual Speech/Lang Therapy

92508 Group Speech/Lang Therapy SPEECH/LANGUAGE CREDENTIALS Are you qualified to bill for direct health related services?

Yes, if you hold a current Speech/Language Pathologist (SLP) full license from the

State of Maryland Department of Health and Mental Hygiene (DHMH).

You can also bill with a Speech/Language Pathologist limited license if you are

under the supervision of a licensed SLP.

Are you qualified to bill for IEP Service Coordination / Case Management?

Yes, as an SLP you can bill for IEP service coordination if you

possess a minimum of a Master’s Degree. You do not need to be a

licensed SLP to bill for monthly IEP service coordination.

Information regarding IEP service coordination may be obtained in the

beginning of this manual, the Medicaid Service Portal Handbook or at

www1.pgcps.org/medicaid. Please note IEP service coordination claims

should be completed by the 5th of the following month unlike health related

claims which are due by the 15th.

http://www.pgcps.org/medicaid


SPEECH/LANGUAGE ASSESSMENTS

You should bill for assessments for all Medicaid-eligible students, not just speech-only students, regardless of whether the student qualifies for service. You can bill for more than one assessment at a time (e.g. articulation and fluency). When completing the Compuclaim service log, record the first date of assessment as the date of service. (e.g. Keila was tested on 9/8, 9/15 and 9/16/15). In the example given, enter 9/8 in Compuclaim as the date of evaluation. The other dates (9/15, 9/16) should be entered as non-billable in Compuclaim. Print, sign and forward (scan) a copy of the assessment report to [email protected] . A bill for your services cannot be submitted until a signed copy of your assessment report has been received.

Remember, although you may provide more than one service in each day, only 1 service may be billed.

MD ONLINE IEP BILLING DOCUMENTATION DOCUMENTATION EXAMPLES FOR SPEECH/LANGUAGE SERVICES

IEP Goal: Allen will increase intelligibility with 80% accuracy. (#1 of #2) Micah worked on his production of /ch/ in initial position of words with new words. He was able to complete this task in all trials 10/10 times. Micah has shown mastery of /ch/ in initial position of words and now will focus on /ch/ in medial position of words. Michelle Helper, MS, CCC SLP

(#3 of #4) Visual cues given by clinician to increase correct production. Allen produced [s, z] in the initial position 50% of the time. Progress is slow but consistent. Michelle Helper, MS, CCC SLP (#4 of #4) Played “Go Fish” during 1st half of session. 90% accuracy. Used oral reading to improve self-monitoring of [s, z]. Allen self- corrected 80% of the time. Progress is adequate. Michelle Helper, MS, CCC SLP

IEP Goal: John will increase fluency by 50% in controlled settings. (#2 of #4). Used modeling to elicit smooth easy beginnings during oral reading. John displayed an average of 4 dysfluencies during one minute readings. John is making progress at this time. Michelle Helper, MS, CCC SLP (#1 of #5) Utilized relaxation techniques to reduce overall body tension. Using deep breathing techniques, John was fluent in conversation 80% of the time. He identified relationship

mailto:[email protected]


between tension and speech production. Good progress was observed today. Michelle Helper, MS, CCC SLP

IEP Goal: Student will increase receptive and expressive language skills with 75% accuracy. (#1 of #3) Carter worked on answering questions related to hypothetical questions w/ 80% accuracy. He required prompts for attention most of the time. He worked better when a peer gave correct examples (75%). Carter was cooperative and participated in all activities. Michelle Helper, MS, CCC SLP (#3 of #6) M/U for 2/17 Joya combined 5 pairs of sentences using "both...and" with 80% accuracy independently. (With a cue she was 100% correct.) Next she listened to 4 passages from Identifying inferences-D Unit 4 (2-3 times each) and retold them with 93% of 4 events/details. She determined if statements were true or false with 92% accuracy. She made 2 of 3 inferences and identified 2 as such. She was able to explain why items were false and an inference. Michelle Helper, MS, CCC SLP (# 2 of #4) Andre’ used context in sentences to figure the meanings of 6 words in sentences and match them to an array of possible meanings with 100% accuracy (No-Glamour Language: Middle School). He then listened to 3 passages from Identifying Inferences G unit 4 (7th grade level) and retold two with 5+ events/details. On the last, he retold with about 65% of the details and also indicated whether statements were true, or false with 75% correct (He made a couple of errors by marking something that should be "true" as an "inference".) He made all of the inferences, and identified 2 of 4 as such. Michelle Helper, MS, CCC SLP Service in classroom (#3 of #4) Malik was seen in the classroom with 2 of his peers. He was able to explain what the assignment was with 2 connected sentences. He conversed with his peers using connected sentences about 80% of the time. Morrison was able to answer 3 out of 4 questions related to the assignment correctly. Michelle Helper, MS, CCC SLP (#1 of #3) Darron participated in a group language project in the classroom. He used picture clippings to describe a story and to share it with the group. He presented his information and responded to questions 4 out of 5 times, with prompts. Michelle Helper, MS, CCC SLP Language and articulation/ intelligibility (#2 of #3) Christopher participated in a language game and enjoyed interacting with his peers. He gave the meanings of multiple meaning words and provided 20 meanings, with 80% accuracy, with prompts. He produced /l/, /y/, and /ch/ when explaining the meanings, with 80% accuracy. Michelle Helper, MS, CCC SLP


PSYCHOLOGICAL SERVICES

PSYCHOLOGICAL SERVICES REIMBURSABLE BY MEDICAID: o Face-to-face encounters with the student.

o Those specified in the IEP as a related service.

o Diagnostic Evaluation/Assessment as ordered by the IEP Team (The result of the

assessment may or may not result in being identified as a child with special needs)

o Services that include:

Psychological Testing

Individual Psychotherapy

Group Psychotherapy

Family Psychotherapy

Therapeutic Behavior Services

PSYCHOLOGICAL SERVICES PROVIDER CREDENTIALS Are you qualified to bill? Yes, if you are licensed by the State of Maryland as a psychologist, psychiatrist, or licensed certified social worker-clinical. ENTERING MEDICAID SERVICE LOGS

The health provider will document each student encounter as usual within Maryland Online IEP (MDIEP). The Medicaid Office will import the MDIEP related logs into the Compuclaim Service Portal weekly. The provider can then validate services with the student within the Compuclaim Service Portal by the 15th of the following month. Please see the Medicaid Service Portal Handbook for instructions on validating health related service logs.

Revised 7/2015 19 | P a g e Medicaid Billing Manual SY15-16

OCCUPATIONAL & PHYSICAL THERAPY SERVICES BILLABLE OCCUPATIONAL & PHYSICAL THERAPY SERVICES The following services can be billed to Medicaid: o Occupational therapy evaluations and re-evaluations

o Group or individual occupational therapy

o Physical therapy evaluations and re-evaluations

o Individual physical therapy

OCCUPATIONAL & PHYSICAL THERAPY PROVIDER CREDENTIALS Are you qualified to bill?

Yes, if you are one of the following:

An occupational therapist licensed by the State of Maryland Department of

Health and Mental Hygiene.

An occupational therapy assistant under the supervision of a licensed occupational therapist. (COMAR 10.46.01.04.) Please refer to COMAR for minimum documentation requirements for supervision

A physical therapist licensed by the State of Maryland Department

of Health and Mental Hygiene.

A physical therapy assistant under the direct supervision of a licensed physical

therapist. (COMAR 10.38.04.02). Direct supervision requires the supervisor to be

personally present and immediately available within the same treatment area as the

physical therapy assistant. ENTERING MEDICAID SERVICE LOGS

The health provider will document each student encounter, as usual, within Maryland Online IEP (MDIEP). The Medicaid Office will import the MDIEP service logs into the Compuclaim Service Portal weekly. The provider can then validate the services within the Compuclaim Service Portal by the 15th of the next month. Please see the Medicaid Service Portal Handbook for instructions on validating the health related service logs.


Case Manager/IEP Service Coordinator Notification

School: ______________________________________________ Dear Parent(s)/Guardian(s) of _______________________________ Student #_______________

Maryland regulations (COMAR 10.09.52) require the Prince George’s County School system to provide on-going service coordination regarding your child’s IEP. This service includes coordinating related services and monitoring your child’s progress in achieving the goals identified in his/her IEP.

The person(s) identified below will serve as your child’s Case Manager/IEP Service Coordinator for the 2015/16 school year and will report monthly on your child’s progress related to his/her IEP.

Please sign and return this letter indicating your consent to receive service coordination and your acceptance of the assigned Case Manager(s). You are free to select your own Case Manager or change them at any time by contacting your child’s school.

Should you have any questions regarding this form, contact your child's current Case Manager at the school.

Sincerely,

______________________________________ ______________________________________ Case Manager (Print Name) Case Manager (Signature) ______________________________________ ______________________________________ Alternate Case Manager 1 (Print Name) Alternate Case Manager 2 (Print Name)

**************************************************************************** I agree to service coordination for my child. I also agree to the appointment of the Service Coordinator(s) identified above as my child’s Medical Assistance (MA) Service Coordinator(s) as outlined in COMAR 10.09.52. I understand that I am free to choose a MA Service Coordinator for my child and that if I wish to change my child’s MA Service Coordinator in the future, I can call the school to make the change. I understand that by not returning the signed form within 15 days constitutes my implied consent and agreement to accept the assigned Service Coordinator / Case Manager(s) as written. _____________________________________________________ Child’s Name ___________________________________________________ ___________________ Parent Signature Date


AUDIT REQUIREMENTS

The Maryland Department of Health and Mental Hygiene (DHMH) along with Maryland State Department of Education (MSDE), Division of Special Education/Early Intervention Service administer the statewide School Based Medicaid Reimbursement Program. MSDE has assembled an Interagency Monitoring Team to conduct audits statewide in order to determine if local educational agencies are in compliance with COMAR 10.09.36, COMAR 10.09.50 COMAR 10.09.52 and COMAR 10.09.40 regulations. DHMH may request reimbursement from PGCPS for any instance(s) of billings not in accordance with Medicaid regulations.

PGCPS system can also be subject to audits from Federal, State and local authorities at any time. In order to meet minimum audit requirements: Billing Records must contain: Name of Medicaid Recipient Name of Provider

Qualifications of Provider

Date of Service

Type and Description of Service The audit file (maintained by Medicaid office) must contain: Parental notification and signed parental consent to bill Medicaid Evidence of parental consent for designated service coordinator / case

manager Service coordinator / case manager’s certifications and licenses Service providers’ certifications and licenses Service logs & service provider notes to support the services billed A copy of the IEP Notes of an IEP meeting including all assessments where student is not found

to be eligible under IDEA. Notes of an emergency meeting when billing for an emergency IEP review and

ongoing care coordination during the same monthly period of time. Attendance records for students Copies of plans of care Treatment plans Transportation logs

Documentation must be maintained by the service coordinator / provider in the LAF showing services were provided to or on behalf of the student on the date Medicaid was billed.

This documentation should be maintained for at least six (6) years.


FRAUD & FALSE CLAIMS STATEMENT

The purpose of this statement is to comply with Section 6032 (Employee Education about

False Claims) of the Deficit Reduction Act of 2005 (DRA) in relation to the Prince George's

County Public Schools (PGCPS) Medical Reimbursement Program. Section 6032 of the DRA

requires providers that make or receive annual Medicaid payments of five million dollars or

more during a federal fiscal year (October 1 to September 30) to educate employees and

certain contractors about federal and state false claims laws and whistle blowing protections

available under those laws.

The False Claims Act (FCA) prohibits any individual or company from knowingly submitting

false or fraudulent claims, causing such claims to be submitted, making a false record or

statement in order to obtain payment from a federally funded program for such a claim, or

conspiring to get such a claim allowed or paid. “Knowing” or “knowingly” means that a person

(1) has actual knowledge of the information; (2) acts in deliberate ignorance of the truth or

falsifies the information. Examples of the type of activity prohibited by the FCA include billing

for services that were not provided and up coding, i.e., billing for a highly reimbursed service in

lieu of the service actually provided…

The FCA imposes civil penalties on individuals and companies who knowingly submit a false

claim or statement to a federally funded program, or otherwise conspire to defraud the

government, in order to receive payment…

The FCA also protects individuals who report suspected fraud. Any person who lawfully reports

information about false claims or suspected false claims that are submitted by others, may not

be retaliated against, demoted, suspended, threatened, or harassed for making such a report.

The FCA provisions are generally enforced by the US Department of Justice.

False representations include knowingly and willfully:

Concealing, falsifying, or omitting a material fact;

Making a materially false of fraudulent statement; or

Using a document that contains a statement of material fact that the user knows to be

false or fraudulent.


INCENTIVE FUNDS PGCPS offers schools incentives for participating in the school-based Medicaid Reimbursement Program. Each school can earn up to 5% of the Medicaid funds it recovers. The incentive monies are available as soon as the school receives their incentive letter from the Medicaid Office. This letter will inform the Medicaid Coordinator of the incentive balance. Each coordinator is responsible for keeping track of their spending and remaining balance. Although these monies are to be spent on health related or special education supplies, the Medicaid Coordinator as well as SPED staff at each school has discretion regarding how this money is spent. Examples of allowable purchases are assessment tools, didactic materials, copy paper, and even rewards or accomplishment stickers and certificates for the students.

Incentive Requisition Forms are located on our website at: http://www.pgcps.org/medicaid

Please submit purchase requests via email to [email protected]. If you have any questions, our secretary’s telephone number is 301.952.6349.

When completing the Requisition Form for incentive funds, please remember to add shipping & handling costs when applicable. If there is no shipping & handling costs, please put -0- (zero) on that line.

Use current catalogs or vendor websites when selecting items. Please do not use catalogs from previous school years, as the prices of items change annually.

You may only order from select, approved PGCPS vendors.

Do not forget to put your name and your school’s name on the requisition form. Only people designated as “Authorized Purchaser” on our Authorized Purchaser form will be allowed to submit orders.

Include the item numbers that are associated with the items or products that you are interested in ordering on the requisition form.

The Medicaid office does not research items, vendors, catalogs or item numbers. The requisition must be completed in its entirety before it can be processed. Incomplete requisitions will NOT be processed.

When your order arrives, you must contact us immediately so that we can receive the items in Oracle. ([email protected] or by phone 301-952-6349)

INCENTIVE FUND REQUESTS NEED TO BE RECEIVED IN THE MEDICAID OFFICE BY MARCH 4, 2016.

http://www.pgcps.org/medicaid




FREQUENTLY ASKED QUESTIONS (FAQS)

How are students identified for the Medicaid billing process? The identification process begins with all Medicaid eligible students with special needs. Further identification of this population is generally achieved two ways – through a school referral process and by conducting a data match with the Maryland Department of Health and Mental Hygiene (DHMH). The data match can be performed up to four times per year.

How long does it take to complete an IEP Service Coordination claim? Once you place a student on your caseload, it will take less than 5 minutes to complete the claim. Can incentive funds be utilized for items in departments or programs other than Special Education? No, incentive funds can only be used for items, and equipment that expand or enhance the services provided to students with special needs. The federal government initiates audits on how Medicaid funds are utilized; therefore, funds should only be used for Medicaid related expenditures.

How does the Medicaid Office determine the loss of Medicaid funds for each school? The Medicaid reimbursement rate for each IEP Service Coordination claim is $150.00. One IEP coordination claim should be completed for each Medicaid-eligible student per month. For example, 10 Medicaid-eligible students x 11 months (Aug-June) = 110 claims. 110 claims x $150 = $16,500 in possible MA revenue.

How does the Medicaid Office track school performance? Once IEP service coordination claims have been processed, each school’s performance is updated to reflect the number of claims submitted for each student per month. Principals are directed to the Performance Report in Compuclaim on a monthly basis to view their schools compliance. The Medicaid Office issues a quarterly report to the CEO, principals and management. How does the Medicaid Office communicate changes/modifications in the policies or process to special education staff? The Medicaid Liaisons communicate changes primarily through email. Additionally changes are often posted on the Google groups sites for each related service. The Medicaid Office website also provides a wealth of information related to our program.


Medicaid Coordinator

Checklist

Review the Case Manager’s caseload list to ensure all students have been

assigned to a case manager for all special education students.

Facilitate timely changes and updates to SchoolMax and MDIEP to reflect

new students and changes in student status.

Collaborate with Case Manager to resolve any outstanding Parental

Consent.

Obtain Case Managers/Service Coordinator Notification forms and scan

them to the Medicaid Office.

Assign a date that IEP Monthly Progress Notes should be completed in

Compuclaim for your review before the end of each month.

Ensure all IEP Monthly Progress Notes are adequate and completed by the

5th

of the subsequent month.

Communicate all information from the Medicaid Office to the case managers.


Case Manager Checklist FOR EVERY STUDENT ON YOUR MEDICAID CASELOAD:

Add all your Medicaid and Non-Medicaid students to your caseload.

Review your caseload list for any student names that have become

Medicaid eligible.

Complete Medicaid Service logs for all your students by the deadline date

set by the Medicaid Coordinator.

Update SchoolMax and MDIEP with new students and any changes in

student status.

Obtain outstanding Parental Consent(s).

Complete a new Case Manager Notification form for any new student

assigned to your caseload or for a student that just became Medicaid

eligible.

Print the IEP Monthly Progress Note, sign it and date it.

Send the signed IEP Monthly Progress Note to the parent/guardian and place a

signed copy in the student’s LAF.


Notes

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