Physical Therapists and Occupational Therapists An Overview Federal - - PowerPoint PPT Presentation

Physical Therapists and Occupational Therapists An Overview

Federal regulations permit and encourage school systems to recover costs from public health insurance (Medicaid) for services identified in a child’s IEP.

The Medicare Catastrophic Coverage Act

(Public Law PL 100-360 July 1, 1988)

PGCPS Medicaid recoveries

have increased by 34% for SY 2012-13

$9 million recovered annually and

funneled back to Special Education

 The school district bills Medicaid for face-

to-face health-related IEP assessments and services:

• Speech/Language Therapy
• Occupational & Physical Therapy
• Nursing
• Psych Services
• Nutrition Services
• Audiological Services

 The school district also bills Medicaid for

• ther IEP services:
• IEP Coordination Services
• Specialized Transportation
• Autism Waiver

• Active IEP
• Health-related discipline documented on

IEP as a related service

• Billed services relate directly to IEP
• Medicaid eligible student under 21
• Qualified practitioner

(proper licensure/ certification, etc.)

For direct (face-to-face) health related services -

• Licensed by the State of Maryland as an

“Occupational Therapist” or a “Physical Therapist”

• PTAs under direct supervision of a licensed PT
• COTAs under supervision of a licensed OT

For IEP service coordination -

• OT/PT licensed by the State of Maryland

Billing forms sent to schools by 10th of each month SLP/OT/PT completes billing forms and attaches Service Logs Billing forms due back 5th of following month

In general, the required documentation for Medicaid billing is:

 Monthly Service Record form  MD Online Related Services Log  Copy of Evaluation Report when billing under the following

codes: Code 10 – PT Evaluation* Code 11 – PT Re-Evaluation Code 20 – OT Evaluation* Code 21 – OT Re-Evaluation * OT/PT evaluations are billable regardless of whether the students qualifies for services.

• Date of services (billable dates only)
• Type of service in “Encounter Code”

 10 - PT Evaluation  11 - PT Re-Evaluation  12 - PT Therapy Service  20 - OT Evaluation  21 - OT Re-Evaluation  22 - OT Therapy Individual  23 - OT Therapy Group

• Session Number
• “See attached log” in Comments field
• Sign & Print Name (original signatures only)
• Attach supporting documentation

 Service Log Documentation:

• Include start and stop times
• Write a goal for each session
• Write goal in measurable terms (e.g. 50%

accuracy or 1 out of 2 times)

• Write detailed description of your service/

therapy; include a measurable outcome (e.g. 3 out of 4 times)

• Sign the log and initial each session

 Update Related Service Log

 Denote “M/U” in “Type of Service” field  Include in the “Description of Services Provided”

field

 The date of the missed session (example: 7/11/2013)  Description of services provided

 A Make-Up session cannot be billed on the same

day of another session

 Non Billable Services - Do not list any other type of session

( i.e., IEP Meetings & Consultations) on the Monthly Service Record.

 Absentee Dates – Do not list any date(s) a student was

• absent. Verify all dates billed against the student’s

attendance record.

 Good Housekeeping

Do submit forms by the 5th of the following month. Do submit a MD Online Service Log for each billing month. Please do not send one log for multiple months of billing. DO staple the MD On-line Related Service Logs to the Monthly Service Record.

All Medicaid Monthly Service Record Forms should be returned to the Medicaid Recovery Office even when services were not provided during the month. It is very important that we maintain an accurate accounting of all forms.

When forms are returned to the Medicaid Recovery Office the schools/providers are given credit for the submission of the forms regardless of whether services were provided during the billing month.

1

• Health Related Services Manual
• Provides guidance related to understanding federal and state MA regulations

billing procedures and process.

2

• Medicaid Recovery Office Website
• Provides access to the Medicaid Health Related Training Manual, Monthly

Service Record forms, Parent Consent forms, and Change of Status forms, {www.pgcps.org/mediaid}

3

• Medicaid Staff
• We are available to personally assist you.

Please visit our website for the most current information and forms. http://www.pgcps.org/medicaid

cindy.spiller@pgcps.org

ricardo.smith@pgcps.org www.pgcps.org/medicaid