Medicaid Billing Module

Medicaid Billing Module

Medicaid Billing Module Nursing Billing Form Changes Services must be documented on the current IEP for meetings held prior to August 1, 2015. Services must be documented on Service Care Plan for IEP meetings held after August 1, 2015. Students with a Section 504 Plan are not eligible for Medicaid Billing. As of August 1, 2015, ICD diagnosis codes are required. ICD-9 codes are in effect through September 30, 2015. As of October 1, 2015, ICD-10 diagnosis codes are required. Health Care Plan For all students receiving specialized nursing services, a Health Care Plan is required per WVDE Policy 2422.7 A copy of the Health Care Plan is to be attached to the Service Care Plan Specialized Nursing Services must be listed on the

students IEP Parents/guardians give consent to release information when giving consent to bill Medicaid. This consent allows information to be shared with those billing for Medicaid Student Demographics Complete this section taking note of the following issues The diagnosis code is to be an ICD 10 code as of October 1, 2015. An ICD-9 code was required for services provided from August 1, 2015 through September 30, 2015. For provider name print the name of the person providing the service. Procedure Codes Complete beginning and end dates for each procedure. For T1001 SE and 92950 typically only one date is entered for beginning and end date. If one of these codes is billed more than once in a month list each date separately within the space available. There is one line for each of the three available

procedure codes. List the total number of units for the month for each procedure. The form is to be used for only one month. Student Demographics and Procedures Sample Medicaid Number Last Name First Name 0000000001 Doe Jane WVEIS # Diagnosis Code

Date of Birth 590000001 F44.5 Conversion disorder with seizures or convulsion 01-01-1900 County 1 Beginning Date 1 Ending Date 1 Procedure Code Units 059 10/01/2015

10/1/2015 T1001 SE 1 School 2 Beginning Date 2 Ending Date 2 Procedure Code Units 201 10/01/2015 10/31/2015

T1000 SE 21 Provider Name 3 Beginning Date 3 Ending Date 3 Procedure Code Units Melanie Smith 10/21/2015 10/21/2015 92950

1 Explanation of Procedures and Caps Part 1 Code Procedure Service Unit T1001 SE Nursing Assessment/Evaluation. 2 events per calendar year T1000 SE School based/independent nursing services licensed. Regarding the specialized healthcare procedures summarized below

92950 Manual Resuscitator 15 minutes units. Each procedure is a maximum of 10 units per instructional day. 10 events per calendar year T1017 SE Targeted Case Management (If an appropriate Targeted Case Management service has been provided, complete the Targeted Case Management Form). 15 minutes per 1 unit Procedures and Caps Part 1 There are three separate procedure codes which can be billed on this form. T1001 SE (Unit = 1 event) are for up to two Assessments per calendar year. The two types of assessments are listed in Part 2

T1000 SE are for direct nursing services. There are 16 different procedures that are billable under this code. Each of them can be provided up to 10 units per day (1 unit = 15 minutes). 92950 (Unit = 1 event) is a manual resuscitator with a cap of 10 events per calendar year. Explanation of Procedures and Caps Part 2 Anaphylactic Reaction Evaluation (T1001 SE) (2 Events/Calendar Year) Seizure Management (T1001 SE) (2 Events/Calendar Year) Manual Resuscitator (92950) (10/Calendar Year) The following procedures use T1000 SE code: Each of the following procedures can be billed, with a maximum of 10 units for each procedure per instructional day, (1 Unit = 15 minutes) Long Term Medication Administration

Catheterization: Clean-Self-Sterile Ostomy Care: Emptying/Changing of Ostomy Pouch Measurement of Blood Sugar with a Glucometer Emergency Medication Administration Mechanical Ventilator Subcutaneous Insulin Infusion Pump/Bolus Oral Suctioning Subcutaneous Insulin by Injection Enteral Feeding (tube feeding) Postural Drainage and Percussion Tracheostomy Care

Inhalation Therapy by Machine Oxygen Administration Peak Flow Meter Anaphylactic Reaction Individual Procedures and Caps Part 2 Assessments include: Anaphylactic Reaction/Evaluation Seizure Management Procedures and Caps Part 2 A unit for T1000 SE is made up of 15 minutes. Minutes from different days within the month may be combined to create a unit. Units cannot be rounded up but may be combined. Example: it takes 5 minutes to give medication each day. On the third day you have a total of 15 minutes which can be billed as one unit. Still

document start and stop times for the 5 minutes on the billing form each day. The Rights When determining the time spent administering medication factor in all aspects involved when ensuring the rights: Right patient Right medication Right dose Right route Right reason Right time Right result Right documentation Time spent completing Medicaid paperwork IS NOT included in the time to administer medication. Targeted Case Management Nurses can also bill for Targeted Case Management (TCM). These are typically indirect actions related

to the students medical needs. See the TCM billing form module for more details. Start and Stop Times Enter the start and stop times for each T1000 SE service on the corresponding date at the bottom of the form. These will be used to easily identify dates billable services were conducted for students with transportation services. If you provide more than one service a day you can enter more than one start and stop time per day. (Example student is administered medications three times per instructional day. List all three start times in one box and all three stop times in one box.) Start and stop times are not required on this form for assessments (T1001 SE) and manual resuscitator (92950). See Sample Form. Start and Stop Times Date Start Time

End Time 1 Date Start Time End Time 16 2 17 3 4 5

6 18 19 20 21 7 22 8 23 9 24

10 25 11 26 27 12 28 13 29 14 30

15 31 Additional Documentation Nurse logs completed during the month for each student must accompany the billing form. If one continuous form is used for services across multiple months, copy the section for the appropriate month. These logs provide specific details to back up the procedures provided to the student during the month. Signature and Credentials The RN who provided the service will sign the form and list credentials RN is a required credential as only Registered Nurses are allowed to bill for nursing services RNs must be an enrolled provider

associated with the school district Terry Riley Coordinator Office of Special Education [email protected] 304-957-9833 ext 53223 WVDE Medicaid Website: http://wvde.state.wv.us/osp/medicaid.html

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