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Billing and Payment Quarterly Webinar Q1 2018
Provider Training
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Presenter: Kaliope Schmidt, Contract Specialist IV Contract Administration and Provider Monitoring
B&P Presentation Sections
• Written Documentation Requirements• HHS Service Delivery Logs
• Required Content on Service Delivery Logs• Provider Responsibility• Edits to Current HHS Service Delivery Logs
• Transportation (SHL/CS)• Transportation Plans
• Common Errors, Helpful Tips and Ideas
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Written Documentation Requirements
General and Specific Requirements for Service Documentation
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Written Documentation Billing Guidelines
For HCS and TxHmL:• Section 3810: General Requirements• Section 3820: Service/Summary Log Required
Content
For Community First Choice PAS/HAB (CFC):• Section 4010: General Requirements• Section 4020: Required Content
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HCS/TxHmL3810: General Requirements
• Legible• Required content:
All service components or subcomponents (except for nursing service components, some professional therapies and transportation as a supported home living activity)
• Name of person• Date service was provided (MM/DD/YY)• Service/service component provided• Written service log or written summary log
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3810: General Requirements• Required content:
Nursing service components must be completed after the service is completed and include:
• Name of person• Date service was provided (MM/DD/YY)• Nursing service component that was provided• Description of activities• Location of service(s)• Exact begin and end times of service• Description of medical need• Description of unusual incidents• Justification for multiple service providers• Justification for length of service
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3810: General Requirements• Unacceptable content for nursing service component
• Ditto marks• Words or symbols referencing other documentation• Non-specific statements such as "had a good day," "did
OK," or "no problem today"• Photocopied• A medication log
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3810: General Requirements• Reimbursement of co-payment or deductible for a
professional therapies subcomponent• Co-payment
Written documentation supporting a service claim to get reimbursement for a co-payment for a professional therapies subcomponent that meets the requirements of Section 4270.
• DeductibleWritten documentation supporting a service claim to get reimbursement for payments made toward a deductible for a professional therapies subcomponent that meets the requirements of Section 4270.
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3810: General Requirements• Transportation as a supported home living (SHL) activity
Written documentation supporting a service claim for transportation as an SHL activity that meets the requirements of Section 4540, Supported Home Living Billing Requirements.
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3820: Service/Summary Log Requirements
• Required content and timeliness for service log
• Written after the service is provided• Description of activities• Location of service• Justification of length of service• Made within a reasonable time after completion of service• Signature of service provider
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3820: Service/Summary Log Requirements
• Required content and timeliness for summary log
• Be written after the service is provided• Identifying information• Description of activities during calendar week• Made within a reasonable time after completion of service• Signature of service provider
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3820: Service/Summary Log Requirements
• Unusual incidents or progress toward objectives
The description of the activities in a written service log or written summary log must include a description of any unusual incident that occurs such as a seizure, illness or behavioral outburst, and any action taken by the service provider in response to the incident.
These incidents should be documented because WSC requires documentation of health and safety incidents.
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3820: Service/Summary Log Requirements
• Unacceptable content:
• Ditto marks• References to other written service logs or
written summary logs using words or symbols• Non-specific statements such as "had a good
day," "did OK" or "no problem today"• Photocopied or pre-filled logs• A medication log
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3820: Service/Summary Log Requirements
• Separate written service log or written summary log for service component, subcomponent or service event
A program provider must have a separate written service log or separate written summary log for each service component or subcomponent, as described in Section 3810, General Requirements, and for each service event as described in Section 3610, 15-Minute Unit of Service.
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CFC PAS/HAB4010: General Requirements
• Legible
• Required contentThe written documentation to support a service claim for CFC PAS/HAB must include:• Person’s name• Date service was provided (MM/DD/YY)• Written service log for each person
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4020: Service Log Requirements
• Required content and timeliness
• Written after the service is provided• Description of activities• Location of services• Justification of length of service• Made within reasonable time after completion
of service• Signature of service provider
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4020: Service Log Requirements
• Unusual incidents or progress toward objectives
The description of activities in a written service log must include a description of any unusual incident that occurs such as a seizure, illness or behavioral outburst, and any action taken by the service provider in response to the incident.
These incidents should be documented because WSC requires documentation of health and safety incidents.
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4020: Service Log Requirements
• Unacceptable content
• Ditto marks• References to other written service logs or
written summary logs using words or symbols• Non-specific statements such as “had a good
day,” “did OK” or “no problem today”• Photocopy/pre-filled• A medication log
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4020: Service Log Requirements
• Separate written service log for service event
A program provider must have a separate written service log or summary log for each service event.
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Service Delivery Logs
HHS Forms: Written Documentation Requirements
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HHS Service Delivery LogsLogs are available for service components or subcomponents that require written documentation before billing for those services. The following services are included on the HHS Forms site:
• Supported Employment/Employment Assistance• Respite• Residential Support Services (RSS) and Supervised
Living (SL)• Day Habilitation• Supported Home Living/Community Support/
Community First Choice Personal Assistance Services/Habilitation
• Host/Companion• Nurse Services
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Form 4117: SE/EA
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Form 4117: SE/EA
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Form 4117: SE/EA Each column is for one day of the week (Sunday–Saturday) and corresponds with the dates entered in the above section.
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SUN MON TUE WED THU FRI SAT
Form 4117: SE/EA The service provider must sign for each service event. One service provider can sign more than once.
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SUN MON TUES WED THU FRI SAT
Form 4118: Respite
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Form 4118: Respite
Form 4118 is used by one service provider per day.
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Form 4118: Respite
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Form 4118: Respite
The service provider must sign for each service event.
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Form 4119: RSS and SL
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Form 4118: RSS and SL
Multiple service providers can use one form. Each service provider that provided a billable service must sign.
Place of service can be: address, description, code, etc.31
Form 4118: RSS and SL
• For billing and payment, initials (mark) are a note within themselves. A narrative is not needed if billable services have been checked off during each shift.
• Staff initials are not required for written documentation.
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Form 4118: RSS and SL
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Form 4120: Day Habilitation
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Form 4120: Day Habilitation
Actual service times are documented on the DH form. Times in and out are necessary. Section 4370 has the breakdown of service units for DH.
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4370: Units of Service for DH• 0.25 units: One hour and 15 minutes of
continuous service time.
• 0.50 units: Two hours and 30 minutes. Two of those hours must be back to back.
• 0.75 units: Three hours and 45 minutes. Two of those hours must be back to back.
• 1 unit: Five or more hours of service. Two of those hours must be back to back.
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Form 4120: Day Habilitation
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Form 4120: Day Habilitation
Only one service provider’s signature is needed per calendar week. If there are multiple staff, there should be multiple signatures.
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Form 4121: SHL/CS/CFC
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Form 4121: SHL/CS/CFCMethod A
The transportation time, number of passengers and number of service providers are the same for all people transported in a single trip:• Transportation time begins when the first person enters
the vehicle and ends when the last person exits the vehicle.
• The number of passengers is the total number of passengers transported during the trip.
• The number of service providers is the total number who provide services during the trip, including the driver.
Method BThe transportation time, number of passengers and number of service providers are determined separately for each person transported in a single trip, in segments that begin and end when the number of passengers or service providers changes during the trip.
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Form 4121: SHL/CS/CFCFormula:
Service Time = [Number of Service Providers x Transportation Time] ÷ Number of Passengers
Service time must be converted to units of service for a service claim as set forth on Appendix III, Conversion Table.
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Form 4121: SHL/CS/CFCThe service provider’s signature is required for each service.One form per service provider.
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Form 4121: SHL/CS/CFC
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Code 16 is only used for transportation (SHL/CS)
Form 4121: SHL/CS/CFC
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Form 4122: Foster Care
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Form 4122: Foster Care
This form is a summary log. The service provider signs it at the end of the calendar week.
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Form 4122: Foster Care
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Form 4122: Foster Care
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Form 4123: Nursing
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Form 4123: Nursing
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Activities noted with an * require additional supporting documentation.
Form 4123: Nursing
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Form 4123: Nursing
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*We are aware of the error in notating begin and end date instead of times. Service providers are required to notate begin and end times of service.
Transportation (TR)
SHL (HCS)/CS (TxHmL)
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Transportation Plan
• A written plan based on person-directed planning and developed with an applicant or person.
• Used to document how transportation as a community support activity will be delivered to support an person’s desired outcomes and purposes for transportation as identified in the PDP.
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HCS – SHL§9.166. Renewal and Revision of an IPC
(a) Renewal of the IPC. At least annually and before the expiration of an individual's IPC, the individual's IPC must be renewed in accordance with this subsection and with DADS instructions.
(4) The program provider must develop, before the effective date of the proposed renewal IPC:
(B) a transportation plan, if transportation as a supported home living activity is included on the PDP.
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TxHmL – CS§9.567. Process for Enrollment
(o) If transportation as a community support activity is included on the PDP, a transportation plan must be developed by:
(1) the program provider if the individual chooses a program provider to provide transportation as a community support activity; or
(2) the service planning team if the individual chooses to receive transportation as a community support activity through the CDS option.
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ITP in Summary• The program provider must develop the Individual
Transportation Plan (Form 3598) if transportation is identified as a need on the PDP and the person chooses the provider option for SHL or CS (transportation).
• If the person chooses the CDS option for transportation, the service planning team is responsible for developing the ITP.
• The ITP is equivalent to the implementation plan for transportation.
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Form 3598, Individual Transportation Plan
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When Is Transportation Used?Transportation can be added to a person’s plan when they don’t have any other community or residential supports to assist with transportation.
• A person in the HCS program can have SHL added to their IPC, if their residence is “own home/family home”.
• A person in the TxHmL program would require CS to be added to their IPC if there are no family supports available, or when CFC has been added.
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When Is Transportation Used?The service components and subcomponents that include transportation as a billable service are:
• Day habilitation (from one DH to another)• Residential assistance (FC, RSS and SL)• Respite• Supported employment• Employment assistance
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When Is Transportation Used?Some examples of when transportation can be added to a person’s IPC and billed are:
• Transporting the person to receive CFC services in the community.
• Transporting them to a physical therapy appointment.
• Transporting them to their day habilitation (own home or family home on IPC).
• Transporting them to camp.
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When Is Transportation Used?Transporting the person is the only billable transportation service. It’s the physical act of driving the vehicle that’s transporting the person. If a person needs assistance during transportation, another service provider can provide escort services to the person, which are billed under CFC.
• Transportation is a face-to-face activity. Time spent waiting to transport can’t be billed as transportation.
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Common Errors, Helpful Tips and Ideas
Knowing is half the battle.
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Common Errors• Missing documentation
• Billing more units than documented
• Photocopied service documents
• Billing transportation services for CFC
• Overlapping services and times (TR, REH, CFC and DH)
• Missing location information
• Missing service provider signature(s)
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Helpful Tips and Ideas• Develop a quality assurance program.• Conduct ongoing service provider training related
to billing guidelines and documentation requirements.
• Review and understand your program provider agreement (contract).
• Subcontractors must be bound to same terms as provider agreement.
• Never create, change, alter or destroy documentation related to a B&P review.
• Self-report errors.
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QuestionsWe will take a few moments to organize the questions we received during the presentation and respond to them. • Questions will be answered in random order.• Multiple questions that refer to the same topic will
be grouped together and answered. • If we do not get a chance to respond to your
questions, or you need further clarification, send inquiries to [email protected].
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B&P Training OpportunitiesBack by popular demand: face-to-face trainings
• Send training requests to the B&P unit mailbox: [email protected].
• The subject line should read: Requesting B&P Training
• Include your provider name and approximately how many people you wish to attend.
• Trainings will be held in Houston (for the time being).
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Thank You
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