THIRD PARTY BILLINGInstruction Manual

2018-2019

“Maximizing the Recovery of Resources for Children With Health-Related and Special Needs”

THIRD PARTY BILLING TEAM

Alanda Speed ASpeed@bcps.k12.md.us

Deveial Foster DFoster@bcps.k12.md.us

Ryan Deal RDeal@bcps.k12.md.us

Sylvia Allen SAllen@bcps.k12.md.us

Call Third Party Billing at 410-396-8948 for TPB System and Provider Support.

Information Technology will not be able to assist you with TPB issues.

200 E. North Avenue, Room 201Baltimore, MD 21202

(410) 396-8948(410) 545-6128 (fax)

THANK YOU, FOR HELPING OUR CHILDREN EXCEL!

ESSENTIAL INFORMATION

Like ITD, TPB can connect to your device to diagnose and correct your TPB issues.

Prevent Medicaid fraud. Only the provider of service can report the service.

First billable service of the year is distribution of a pre-printed Service Coordination/Medical Assistance Consent Letter. This also applies to students new to the school, or new to the Service Coordinator, who is not an alternate on the existing letter. Send Third Party Billing a copy of the form after it is signed by the parent. Then, properly document and report services monthly using the TPB/SAS System.

Clinicians providing Speech-Only services must first distribute a pre-printed Service Coordination/Medical Assistance Consent Letter. Send Third Party Billing a copy of the form after it is signed by the parent. Then, properly document and report services monthly using the TPB/SAS System.

Health-related assessments must be reported using the TPB/SAS System.

Report services monthly to experience the shortest system response times.

TPB access may be affected by changes in school assignments, job-titles, roles, MSDE certification, or MDH licensure.

Maintain active licensure and/or certification to remain a Medicaid billable provider. If it lapses, notify your administrators that you cannot report services.

Use Google Chrome to access the TPB/SAS System. Disable the pop-up blocker to run and view reports.

ITD One Call Center can reset your network password. They cannot assist you with any other aspects of the TPB/SAS System.

UCL tab has been removed, although it may appear in some screen shots.

Students aged 7 or lower cannot have face-to-face service coordination without the parent/guardian present.

The Interagency Medicaid Monitoring Team Audit of 2016-17 services occurs November 9, 2017. Supporting documentation of services must be signed by the provider of service and placed in the student’s confidential folder, which is used for our Federal, State, and Self-Monitoring Audits.

TABLE OF CONTENTS

OVERVIEW

FALSE CLAIMSFederal False Claims ActTypes of Fraud Prosecuted Under the False Claims ActMaryland False Health Claims ActBaltimore City Schools and the False Claims Act

THIRD PARTY BILLING SYSTEMGetting to the SystemLogging OnSystem Access

IEP MEETINGSReporting an IEP MeetingFrequently Asked Questions

SERVICE COORDINATIONPrinting the Service Coordination/Medical Assistance Consent LetterReporting Service CoordinationPrinting the Service Coordination Activity LogFrequently Asked Questions

RELATED SERVICESAssessments - Student Already in ServiceAssessments - Student New to Special EducationClinical Therapy Sessions Speech Only - Service CoordinationInfant & Toddler IFSP only - Assessments, Therapy, and Service CoordinationFrequently Asked Questions

THERAPEUTIC BEHAVIOR SERVICESCOMAR 10.09.50 Definitions Requirements for Medicaid BillingFrequently Asked QuestionsMaryland Online IEP Documentation

TROUBLESHOOTING

OVERVIEW

Medicaid reimburses some costs of direct and administrative services rendered under IDEA. It is an obligation and requirement of City Schools to pursue this reimbursement and it is the obligation of staff and contractors to provide the information necessary for billing Medicaid and to sustain audit. Monies recovered from Medicaid are used to support special education services and school health. The Office of Third Party Billing coordinates and monitors these services for compliance with Federal and State regulations.

All providers must understand that Medicaid is a medical insurance agency with fiduciary responsibility to the US taxpayer and to Congress. Medicaid accepts its charge to reimburse us for legitimate costs we entail serving our children. In return, Medicaid demands that we adhere to a medical model for the provision and documentation of these services. This means providers are properly licensed and every service is fully charted. Medicaid’s expectation is identical to the expectation every staff person has when he or she visits his or her own physician. We expect our health care provider to be qualified to serve us, and we expect that the notes that arise for our encounter will ensure we are correctly treated the next time we require care. We expect City Schools’ staff to embrace these principles completely.

FALSE CLAIMS

Federal False Claims Act

The False Claims Act (“Act”) 31 U.S.C. §§3729-3733, a federal law, is the single most important tool taxpayers have to recover the billions of dollars stolen through fraud by government contractors every year. In short, the Act is a whistleblower statute.

Under the Act, those who knowingly submit, or cause another person or entity to submit, a false or fraudulent claim for payment of government funds, or makes a false statement to get such a claim approved, is liable for both damages and penalties.

A defendant is liable: For three times the damages sustained by the government due to the false claim; plus A civil penalty of $5,500 to $11,000 per false claim

The defendant’s intent to defraud the United States is not a requirement of liability. Instead, the statute uses a “knowing” standard defined as:

Actual knowledge that the claim is false; Deliberate ignorance as to the truth or falsity of the claim; or Reckless disregard as to the truth or falsity of the claim

In summary, the False Claims Act imposes liability on any person who submits a claim to the federal government that is false.

The False Claims Act contains qui tam, or whistleblower, provisions. Qui tam is a unique mechanism in the law that allows citizens with evidence of fraud against government contracts and programs to sue, on behalf of the government, in order to recover the stolen funds. In compensation for the risk and effort of filing a qui tam case, the citizen whistleblower, informant, or “relator” may be awarded a portion of the funds recovered, typically between 15 and 25 percent. A qui tam suit initially remains under seal for at least 60 days during which the Department of Justice can investigate and decide whether to join the action.

More particularly, the government (usually the United States Attorney’s Office for the district in which the complaint was filed) has 60 days to investigate the complaint and decide whether it wants to intervene in the case. If the government chooses to intervene, it exercises primary responsibility for the action. If the government declines to intervene, the informant may pursue the action independently.

In order to recover damages for violation of the Act, the government or informant must establish that all of the following occurred:

The person presented or caused to be presented to an agent of the United States a claim for payment;

The claim was false or fraudulent; The person knew the claim was false or fraudulent; and The United States suffered damages because of the false or fraudulent claim.

If the case is successful, the informant is entitled to share in a percentage of the government’s recovery, including the damages and penalties. If the government intervened in the case, the informant is entitled to 15% to 25% of the total recovery, depending on the extent to which the informant substantially contributed to prosecuting the action. If the government did not intervene, the informant is entitled to 25% to 30% of the total recovery.

The Act provides protection to qui tam informants who are discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of their employment because of their furtherance of an action under the Act. Remedies include reinstatement with comparable seniority as the qui tam informant would have had but for the discrimination, two times the amount of any back pay, interest on any back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys’ fees. Maryland has recognized a public policy exception to the “employment at will doctrine.” This exception would prohibit the BCPSS from disciplining an employee from filing a claim under the Act.

Congress recognized that the federal government alone, with its limited resources, was overmatched in the fight against rampant fraud. The Act created incentives for private citizens with evidence of fraud to commit their time and resources to supplement the government’s efforts. By doing so, Congress put into play a powerful public-private partnership for uncovering fraud against the federal government and obtaining the maximum recovery for American taxpayers.

Types of Fraud Prosecuted Under the False Claims Act

It is impossible to list all types of frauds that have been prosecuted under the False Claims Act, but the following list gives some idea of the scope of false claims submitted that have been uncovered to date:

Billing for goods and services that were never delivered or rendered; Submitting false service records or samples in order to show better-than-actual

performance; Performing inappropriate or unnecessary medical procedures in order to increase

Medicare/Medicaid reimbursement; Billing for work or tests not performed; Automatically running a lab test whenever the results of some other test fall within a

certain range, even though the second test was not specifically requested; Double billing – charging more than once for the same goods or service;

Phantom employees and doctored time slips create charges for employees that were not actually on the job, or bill for made-up hours in order to maximize reimbursements;

Up coding employee work involves billing at doctor rates for work that was actually conducted by a nurse or resident intern;

Being over-paid by the government for sale of a good or service, and then not reporting that overpayment;

Billing in order to increase revenue instead of billing to reflect actual work performed.

Maryland False Health Claims Act

The Maryland False Health Claims Act became law on October 1, 2010. It addresses fraud against all state health plans and programs, including Maryland Medicaid to whom City Schools submits claims. The Maryland False Health Claims Act is Maryland’s version of the Federal False Claims Act.

Baltimore City Schools and the False Claims Act

Baltimore City Schools encourages its employees, contractors, and vendors to report all instances of fraud, waste, or abuse. Such conduct is harmful to Baltimore City Schools’ efforts to utilize all available resources in the most prudent manner. Any employee making a report may do so anonymously if he or she chooses. Employees may report any violations of the Act to their immediate supervisor or to the Chief Operating Officer. All information reported to the Chief Operating Officer by any employee shall be kept confidential to the extent that confidentiality is possible in the context of any resulting investigation. There may be a point where an employee’s identity may become known or may have to be revealed in certain instances if/when governmental authorities become involved. In accordance with the policy of Baltimore City Schools, all allegations of suspected fraud, waste, or abuse will be investigated. Prompt and effective remedial action will be taken where appropriate.

Baltimore City Schools adheres to a non-retaliation policy for employees that report any violations pursuant to the Act. Under the Act, employees cannot be subject to retaliation for reporting false claims act violations, or billing concerns. The Act includes whistleblower protection provisions as set forth above. The Chief Operating Officer should confer with the Office of Legal Counsel regarding any questions or concerns regarding the Act.

Baltimore City Schools requires all of its officers, directors, employees, contractors, and agents to comply with all federal and state laws and regulations governing the administration and operation of a school system. Baltimore City Schools prohibits its officers, directors, employees, contractors, and agents from knowingly submitting to any federally or state funded program, a claim for payment approval or reimbursement that includes false or fraudulent information, or is based on false or fraudulent documentation. This includes claims submitted to Third Party Billing, a federally funded program. Retaliation in any form against an individual is strictly prohibited for a person who

Makes a good faith report of suspected fraud, waste or abuse; Files a complaint under the Act; or Participates in an investigation or litigation under the Act

Compliance with the Act also assists Baltimore City Schools with some of the underlying purposes of Article 1-101 of the Baltimore City Board of School Commissioners’ and Chief Executive Officer’s Administrative Regulations Procurement Policies as follows:

To provide for increased public confidence in the policies and administrative regulations followed in public procurement;

To ensure the fair and equitable treatment of all persons who transact business with the Board;

To provide increased economy in the BCPSS procurement activities and to maximize, to the fullest extent practicable, the purchasing value of public funds of the BCPSS; and

To provide safeguards for the maintenance of a procurement system of quality and integrity

Additional information:

Medicare Fraud Center Maryland False Health Claims Act

THIRD PARTY BILLING SYSTEM

Getting to the System

Open Google Chrome. Type bcpss 9041, then enter.

Click on the Overview link.

Scroll down. Under Tools and Resources select the link for the TPB/SAS System.

Logging On

Logon using your network ID and password.

Before each use, you promise to not commit Medicaid fraud. Report your services only.

System Access

Access to the Third Party Billing System is granted by the Third Party Billing Team. Send requests for access to tpball@bcps.k12.md.us . Include your name, assigned school(s), network logon ID, job title, and role (Service Coordinator, IEP Team Associate, or Related Services Provider.) Certification and/or Licensure are verified by a Certification file received daily from Human Capital, and used by TPB to determine if Medicaid can be billed for your services. Please email Certification@bcps.k12.md.us, if you have certification questions or concerns.

The following school-based job titles or roles are eligible to request access to the system: IEP Team Associate * Special Educator * Principal * Vice Principal * Ed. Associate *

* Requires Active Standard Professional or Advanced Professional Certification by MSDE Audiologist * Occupational Therapist * Physical Therapist * Psychologist * Licensed Professional Counselor * Social Worker * Speech /Language Pathologist *

* Requires Active Professional Licensure by Maryland Department of Health (MDH)

Access may also be granted to employees acting out of title, but who are fulfilling any of the above-mentioned roles. TPB uses the employee’s City Schools network ID and password to provide access to the system. TPB does not know your password. Please contact the ITD Help Desk at 443-642-3000 for assistance with your password. Third Party Billing reserves the right to grant or suspend system access.

IEP MEETINGS

Reporting an IEP Meeting

Your name is displayed. Click the IEP tab to report meetings when you served as IEP Chair.

For your assigned schools, meetings you need to report are marked . Report Meeting is a hyperlink that will take you directly to the entry screen.

Information is from MD Online IEP and cannot be changed. Verify Meeting Date, select Type of Meeting, click Placed In Folder, and Submit.

Review your entries, then click Submit, if correct. Otherwise, click Back to make a correction.

The meeting has been reported and is no longer listed. As this was the only meeting for this school, there is no report to display.

Select Reports. Six months of data are available.

Transaction History Report displays services for the logged-in provider. Available for Current Month, Current Quarter, and Prior Quarter. Disable pop-up blocker. Select Period and run.

Save trees. Do not print these reports. Close both report tabs to return to the Reports Menu.

Missing IEP Meetings Report displays all billable meetings. If all meetings are entered, there is no report. Meetings appear when they have been finalized in Maryland Online IEP. If your school has a large Specialized Services population, check this report weekly.

Service Coordination Report displays ‘1’ for services reported for students. Missing services are indicated by ‘.’. Report end date is previous month. Patterns of zeros may indicate unreported services by a single provider. TPB Compliance percent has been added.

School Transaction History Report displays services for students reported by all providers at the school. Available for Current Month, Current Quarter, and Prior Quarter. All of your assigned schools will be displayed.

Consent Form Creator generates a pre-printed Medical Assistance/Service Coordination Consent Form, which must be distributed the day they are printed.

If your session has not expired, you will get a summary of your session activity at Log Out.

IEP Team Associates - Frequently Asked Questions

What are the TPB responsibilities of the IEP Team Associate?Responsibilities may include:

Serve as Chairperson of the IEP Committee for meetings held at your school(s) Report all finalized IEP meetings Resolve meeting discrepancies reported by TPB as missing each month Submit copies of all Service Coordination/Medical Assistance Consent Letters that are

signed by the parent(s)/guardian(s) Print student’s attendance and place a copy in their confidential folder. Do this

quarterly. What documentation is required for Medicaid billing?In the Student’s confidential folder, IEP Meetings are documented by:

Completed Maryland Online IEP Completed IEP Meeting Attendance Sheet Copy of Notice of Invitation to the Parent

How will I know my services have been reported to TPB?Verification is provided after the 2nd submit, at the end of your session when you click on the Log Out tab, and via the Reports function.

How does my administrator access this information?Missing IEP Meetings and Service Coordination Reports are available under the Reports tab.

Forms Sample IEP Meeting Attendance Sheet

School#: 0595Student: Carlos Deal Pif: 1165665 DOB: 07/04/96 Meeting Date: 10/13/16

Meeting Type:☐ Evaluation/ Eligible ☐ Evaluation/ Not Eligible ☐ IEP Developed ☑ IEP Reviewed/ Revised☐ Re-evaluation Planning ☐ Re-evaluation ☐ IEP Review/ Manifestation

Print Name Title SignatureE. Urqhart IEP Chair E. UrqhartG. Kellion Occupational Therapist G. Kellion

A.Monderal Physical Therapist A. .MonderalJ. Joseitan Principal J. JoseitanI. Panella Special Educator I. PanellaR. Beckett Speech/Language Pathologist R. Beckett

Please place this document with the IEP in the student’s confidential folder.

IEP Meeting Attendance Sheet

School#: ________ Student: ____________________ Pif: _____________ DOB: ___________ Meeting Date: ________________

Meeting Type:

☐ Evaluation - Eligible Evaluation - Not Eligible☐ IEP Developed☐ IEP Reviewed - Revised ☐

☐ Re-evaluation Planning ☐ Re-evaluation ☐ IEP Review - Manifestation

Printed Name Title Signature

IEP Chair

General Educator

Occupational Therapist

Parent/Guardian

Physical Therapist

Principal/ Principal’s Designee

Psychologist

Social Worker

Special Educator

Speech/Language Pathologist

Student

Please place this document with the IEP in the student’s confidential folder.

SERVICE COORDINATION

Printing the Parental Consent Letter

Medicaid cannot be billed without the parent’s consent. Pre-printed letters arrive in time for distribution on the first day of school. If you did not receive a pre-printed consent letter for a student, go to the Reports tab. Click Consent Form Creator.

Search for by student ID, last name, or first name. Highlight the student and click to select.

Select the language. Click Create Form and a new window opens. Verify the student’s information.

For a print preview, hold down the Ctrl key and press ‘P’. To change the letter to one page, select ‘+ More Settings...’. Change margins to Minimal and uncheck all options. Uncheck Headers and footers. Click ‘Print’.

If you are the primary Case Manager/Special Educator for the student, this letter must be completed and distributed before any services can be reported for billing. Print your name and the names of two (2) alternates. Sign, make a copy, then give the original to the student for the parent’s signature. Send a copy of the form signed by the parent to Third Party Billing Room 201.

Reporting Service Coordination

Your name is displayed here. Click the SC tab. Report services that you provided.

If your student is not listed, Search Students. You may need to scroll down to get to the button.

Type the student’s pif, last name, or first name. Click the highlighted entry, then Search to pull your student.

Mouse over Update to use the hyperlink. Click Update to enter services.

Reported services are displayed. Student info is from Online IEP and cannot be changed.

Use the calendar widget to select the date you provided the service.

Use the drop down list and click the service you provided. First service of the year is Sent Parent Service…Form.

Outcome Statement is automatically generated. Click submit to promise placing supporting documentation in the student’s confidential folder.

Verify the information you entered. If correct, click Submit. If incorrect, click Back and make corrections.

The service has been reported.

Reports

Click the Reports tab.

Service Coordination Report displays ‘1’ for services reported for students. Missing services are indicated by ‘.’. Report end date is previous month.

Transaction History Report displays services for students reported by the logged in provider. Available for Current Month, Current Quarter, and Prior Quarter.

Printing the Service Coordination Activity Log

Select the SC tab. Find your student. Hold Ctrl –P and click print.

The Service Coordination Activity Log and supporting documents should be placed in the student’s folder when any of the following occurs:

Student transfers mid-year; Student is dismissed from service mid-year; School year ends.

If your session has not expired, when you log off the system you will see:

Frequently Asked Questions

What are examples of billable service coordination?Billable service coordination may include:

Meetings/conferences with child or parent/guardian; Progress reports/IEP report cards; Letters; Telephone calls…NOT messages left on an answering machine; Home visits; Emails (printed).

Who can be a service coordinator?A Special or Regular educator who is most familiar with the student’s needs, who coordinates the student's IEP, and is certified by the state of Maryland with a Standard or Advanced Certificate. Related Service providers with Speech only students are service coordinators for those students.

Can a student have more than one service coordinator?No. The student must have one primary and at least one alternate coordinator. The primary service coordinator must be certified, identified on the IEP by name and title, and approved by the student’s parent/guardian. The alternate service coordinator(s), also certified, should appear on the Service Coordination/ Medical Assistance Coordination Consent letter sent to the parent. The primary coordinator is expected to provide services and enter service details in the Third Party Billing System.

What are the responsibilities of the service coordinator? Provides coordination of care compliant with the IEP; Participates in the planning and implementation of the IEP; Makes contact with the parent/guardian and/or student throughout each month; Reports service details in the Third Party Billing System by the last day of the month in

which services occur. Places appropriate supporting documentation of services in the student’s confidential

folder; Sends a copy of the Service Coordination/ Medical Assistance Service Coordination

Consent Form to Third Party Billing after the parent signs it;

Under what conditions should service coordination should be reported to TPB? The student must have an IEP. Service coordination cannot be billed for students who

are not enrolled in special education; There has been a direct contact (by meeting, visiting, telephoning, or writing) with the

parent, guardian, or student; this direct contact occurs expressly to coordinate the IEP. When can the Service Coordination/ Medical Assistance Coordination Form be sent home?On the student’s first day on your case load.

How will I know my services have been reported to TPB?Verification is provided after the 2nd submit, at the end of your session when you click on the Log Out tab, and via the reports function.

How does my administrator access this information?The Service Coordination Report is available under the Reports tab. Can I bill for 504 or Service Plans? No. Students with 504 Plans or Service Plans are not billable.

Attendance Letter

Student's Name: _________________________ School #: ________

Student ID: _________ Date: ___________

Dear Parent/Guardian:

This letter is to inform you of ________________________’s absence(s) during this school year.

When your child is absent from school, he/she does not receive the quality instruction that has been prepared for him/her and the Individualized Education Plan cannot be fully implemented. In order for your child to obtain maximum success, please be certain that your child is present each day.

Month # Days Absent

September

October

November

December

January

February

March

April

May

June

If you have questions or concerns, please contact me at ________________________.

Sincerely,

Teacher's Name: __________________ Teacher's Signature: ___________________

Late To School Letter

Student's Name: _________________________ School #: ________

Student ID: _________ Date: ___________

Dear Parent/Guardian:

This letter is to inform you of ________________________’s lateness to school this school year.

The Individualized Education Plan cannot be fully implemented when your child is late for school. In turn, this affects your child’s ability to achieve maximum success and the quality instruction that has been prepared specifically for your child. Please express to your child, the importance of being on time for school each day.

Month # Days Late

September

October

November

December

January

February

March

April

May

June

If you have questions or concerns, please contact me at ________________________.

Sincerely,

Teacher's Name: __________________ Teacher's Signature: ___________________

IEP Team Progress Report to Parent

Student's Name: ________________ Student ID: _________ Class: ____ Date: _________

Dear Parent/Guardian:

This letter is to inform you of the progress your child, _______________________, has made on his/her current IEP goals. The areas addressed on the IEP are listed below.

Comments Language Arts MathematicsComes to class on timeComes prepared for class with appropriate materialsCompletes class workCompletes homeworkTest/quiz grades are passingMakes up missed assignmentsAttends class dailyNotebook is organizedPays attention and stays on taskDisplays appropriate behaviorMakes a sincere effort to achieveQuality of work is improvingDisplays a positive attitudeGrade: G - Good S - Satisfactory P - Poor U- Unsatisfactory

Overall IEP Progress:________________

Please continue to work with your child on his/her IEP goals. If you have questions or concerns regarding this progress report, please contact me at _______________.

Sincerely,

Teacher's Name: __________________ Teacher's Signature: ___________________--------------------------------------------------------------------------------------------------------------

Please sign and return this section:

I have reviewed ______________________'s Progress Report.

_______I would like to schedule a conference with you on __________________.

_______Please call me to schedule an appointment with you at a convenient time.

__________________________________ ________________ Parent's Signature Date

IEP Progress Report

Student's Name: _________________________ School #: ________

Student ID: _________ Date: ___________

Dear Parent/Guardian:

This letter is to inform you of the progress your child, _______________________, has made on his/her current IEP goals. The areas addressed on the IEP are listed below.

IEP Area of Content Making Progress

Needs More Assistance Comments

Reading

Written Language

Math

Speech/Language

Counseling

Other_________________

Overall IEP Progress: _______________

Please continue to work with your child on his/her IEP goals and if you have questions or concerns regarding this progress report, please contact me at_______________________.

Sincerely,

Teacher's Name: _____________________ Teacher's Signature: ______________________---------------------------------------------------------------------------------------------------------------------

Please sign and return this section:

I have reviewed _________________________'s progress report.

_________I would like to schedule a conference with you on ______________________.

_________Please call me to schedule an appointment with you at a convenient time.

________________________________________ _______________ Parent's Signature Date

Parent IEP Update Newsletter

Student's Name: _________________________ School #: ________

Student ID: _________ Date: ___________

This is a list of activities that will assist you in helping your child master reading goals and writing goals on his/her IEP. The activities listed will help your child increase his/her reading comprehension, decoding, and reading vocabulary skills. These activities will also help your child remember the reading objectives and writing objectives that we are working on in school that are listed on his/her IEP.

As you know, all students benefit from extra reading experiences. Share the joy of reading with your child through these activities.

When you read aloud to your child or your child reads to you:

Stop part of the way through the story and ask your child to predict what will happen next.

Ask your child how the story made him/her feel.

After reading the story, ask your child to suggest a different way the story could have ended and write some sentences with supporting details.

When you go through your mail, let your child open and read advertising mail you do not want.

In the car, read highway signs aloud with your child.

Let your child help you read and prepare a recipe. At the library, look for special cookbooks for children.

Take books along in the car when traveling on errands or vacations.

Reading together is fun! Help your child start reading more today.

Sincerely,

Teacher's Name: _________________ Teacher’s Signature: ________________________

RELATED SERVICES

Assessments

Assessments can be billed whether a student is found eligible or ineligible for an IEP. All assessments must be reported via the TPB/SAS System. A student ‘New to Special Ed.’ has not had an evaluation meeting. A student ‘Already in Service’ has an existing IEP.

Assessments: Already in Service

Click Already in Service. Type the student’s pif, last name, or first name.

Click Get Data.

Student information is populated from Maryland Online IEP and cannot be changed in SAS. This information will not populate if the student has transferred, exited, or has an IEP still in draft.

Select the type of service you provided from the Procedure Code drop down list.

Use the calendar widget to select the assessment date.

Select the Diagnosis Code from the drop down list.

Indicate that your report has been signed, dated, and placed in the confidential folder.

Verify your data. If correct, click Submit. If incorrect, click Back and make corrections.

Assessment: Student New to Special Education

These are students who have never had an evaluation meeting. IFSP services are not reported on this screen.

Select the school from the drop down list. Carefully enter all fields. A valid pif is required. This is a properly completed form.

Click Submit and review your entry. Click Submit to report the service.

The assessment has been reported.

Reports

Click the Reports tab.

Transaction History Report displays all services for students reported via TPB/SAS System by the logged in provider. Available for Current Month, Current Quarter, and Prior Quarter.

Speech Only Students: Service Coordination.

Please refer to the section on Service Coordination.

Related Services - Frequently Asked Questions

Who is a related service provider? A related service provider is a currently licensed and/or certificated City Schools or contractual audiologist, social worker, speech/language pathologist, psychologist, occupational or physical therapist, psychiatrist, licensed clinical professional counselor or nurse who provides direct medical services to students pursuant to special education.

How are services submitted to Third Party Billing?The Office of Related Services submits an electronic file of Encounter Tracker (ET) services. ET submissions to Third Party Billing do not include clinical notes.

What are my responsibilities as a related service provider? Submit IEP services data via Encounter Tracker Write a descriptive clinical note Watch your dates! The date on the clinical note must match the service date in

Encounter Tracker. Services on weekends or days when school is closed must be supported by professional notes.

Verify student attendance Report services via the Third Party Billing System:

o Assessments – Current students have an existing IEP. New students have not had an evaluation meeting.

o Service Coordination (for Speech Only students)o Infants and Toddlers (IEP and IFSP)

Places appropriate supporting documentation in the student’s confidential folder Provides coordination of care consistent with the intent of the IEP Participates in the planning and implementation of the IEP Reports all services by the last day of the month in which they occur.

Are indirect services, such as consultations, billable? No. Third Party Billing cannot bill for indirect IEP services.

Can I bill for 504 and service Plan students?No. Third Party Billing cannot bill for students with a 504 or Service Plan.

INFANT & TODDLER IFSP SERVICES

Service Coordination: Service Coordination/Medical Assistance Consent Letter

Medicaid cannot be billed without the parent’s consent. Print the letter, in English or Spanish, found at the end if this section. Complete and give to the parent for their signature. Provided letters are in. Send copies of letters signed by the parent to Third Party Billing. This is the first billable service for the Service Coordinator.

Assessments, Therapy, and Service Coordination

Report services for students who have an IFSP. Select IFSP from the menu. Student information comes from Maryland Online IFSP Birth-to-Five to verify student data. Do not use the Medical Assistance Number to locate the student.

Search using Last Name or ChildID. Mouse over the student to highlight the name, then click to select. Then click Get Student Information.

Here is the result.

To report an Assessment, use the Assessment Date widget and leave Service Date blank. If you are reporting a Therapy session, use the Service Date widget and leave Assessment Date blank. All calendar widgets function in the same manner.

Select the Procedure code.

Select the Diagnosis code, then enter Assessment or Therapy time in minutes. Submit and review your entry.

Assessment Date is blank for therapy. Submit if correct. Click Back to make corrections.

The service is reported. Enter another service for Nova or clear the form to search for another student.

Reports

Click the Reports tab.

Transaction History Report displays services for students reported by the logged in provider. Available for Current Month, Current Quarter, and Prior Quarter.

THERAPEUTIC BEHAVIORIAL SERVICES

COMAR 10.09.34 Definitions

Therapeutic Behavioral Service means an intensive, rehabilitative service that is documented in the written behavioral plan and is intended to:

(a) Provide the recipient with behavioral management skills to effectively manage the behaviors or symptoms that place the recipient at risk for a higher level of care; and

(b) Restore the recipient's previously acquired behavior skills and enable the recipient to develop appropriate behavior management skills.

Therapeutic Behavior Aide means:

(a) A health care professional or a nonprofessional who is supervised by an individual who is licensed, certified, or otherwise legally authorized to provide mental health services independently in the state where the service is rendered;

(b) Trained and supervised by a therapeutic behavioral service provider to implement a behavior plan; and

(c) Available on-site to provide one-to-one behavioral assistance and intervention to accomplish outcomes specified in the behavioral plan.

IEP: TBS, placement on IEP as a Health Related Service

(a) Therapeutic Behavior Services are preauthorized through the IEP or IFSP process;

(b) Under supplemental services or health related services;

(c) Frequency – Daily;

(d) The authorized qualified provider, Therapeutic Behavior Aide (TBA) is a drop down option on Maryland Online IEP.

(e) Unacceptable Service Providers for Therapeutic Behavior Services are 1:1 Adult Support, Instructional Aide, Family Member, Family Friend, or anyone living in the student’s home.

Required Documentation (on Therapeutic Behavior Aide - Service Log)

(a) Date of service;(b) Student’s name;(c) TBA’s name and signature;(d) Supervisor’s name and signature;(e) Student’s Schedule /Location of service for each 30 minutes of service; (f) BIP Components;(g) Documentation of 15-minute increments;(h) Number of ‘Y’ units for covered services each day.

Training and Supervision Inclusions

(a) Clinically accepted techniques for decreasing or eliminating maladaptive behaviors;(b) Implementing a behavior plan;(c) Documenting interventions and outcomes;(d) Identifying the needs and characteristics of the recipient;(e) Documentation that the training is related to the behavior management: including

principles of behavior change and child development, clinically accepted techniques for decreasing or eliminating maladaptive behaviors.

Required Training Documentation

Crisis Prevention Intervention (CPI) Training must occur at a minimum of once per school year and include:

(a) Name of the course, workshop, or in-service;(b) Date of training;(c) Length of time;(d) Copy of the agenda and course description;(e) Name and qualifications of the instructor.

IMMT: Documentation Required for Audit

BIP in effect for the date of service being reviewed IEP or IFSP in effect for the date of service being reviewed Daily treatment logs, signed by both the behavior aide and supervisor Supervision Logs, monthly for each behavior aide providing services Training Logs, for each behavior aide providing services License for the supervising professional

Maryland Online IEP Documentation

IEP: Special Considerations and Accommodations

IEP: Special Considerations and Accommodations

SAMPLE Therapeutic Behavior Aide - Service Log 

Student: Michael Doesk DOB: 06/08/2008 School #: 307 Student ID: 1402659Date: 06/05/17 BIP Implemented by

TBA? (Y/ N)Time: Activity/Location Behavior 1 Behavior 2 Behavior 3 BIP Components 15 min. 15 min.

7:30-8:00 A B C D 8:00-8:30 A B C D8:30-9:00 Arrival O l l l A B C D Y Y9:00-9:30 Homeroom O l A B C D Y Y

9:30-10:00 Language Arts l l O A B C D Y Y10:00-10:30 Resource O O A B C D Y Y10:30-11:00 Math l l l A B C D Y Y11:00-11:30 Resource l l l A B C D Y Y11:30-12:00 Resource l O A B C D Y Y12:00-12:30 Lunch O l A B C D Y Y12:30-1:00 Recess O l A B C D Y Y1:00-1:30 History l l l l l l l A B C D N N1:30-2:00 Resource l O A B C D N Y2:00-2:30 OT O l l A B C D Y Y2:30-3:00 Resource l l A B C D Y Y3:00-3:30 Dismissal O l l A B C D Y Y3:30-4:00 A B C D

Supervisor: Ryan Deal Signature: Ryan Deal Title: LCSW-CAide: Minnie Moran Signature: Minnie Moran Total Y’s

 

Date: 06/05/17 BIP Implemented by TBA? (Y/ N)

Time: Activity/Location Behavior 1 Behavior 2 Behavior 3 BIP Components 15 min. 15 min.7:30-8:00 A B C D 8:00-8:30 A B C D 8:30-9:00 A B C D 9:00-9:30 Doctor appt. A B C D

9:30-10:00 Language Arts l l l l l l l A B C D N N10:00-10:30 Language Arts l l l A B C D N N10:30-11:00 Resource l l A B C D Y Y11:00-11:30 Resource l A B C D Y Y11:30-12:00 Math l O A B C D Y Y12:00-12:30 Lunch O O A B C D Y Y12:30-1:00 Recess O O A B C D Y Y1:00-1:30 History l l l A B C D Y Y1:30-2:00 Resource O O A B C D Y Y2:00-2:30 Speech l l A B C D Y Y2:30-3:00 Speech l l l l l l l A B C D N N3:00-3:30 Dismissal O l l A B C D N N3:30-4:00 A B C D

Supervisor: Ryan Deal Signature: Ryan Deal Title: LCSW-CAide: Minnie Moran Signature: Minnie Moran Total Y’s

 

BIP Behavior 1 Frequently refuses to complete his work, can be sleeping or walking around

BIP Behavior 2 Engages in disruptive and noncompliant behavior as overly playful and silly and behaviorally inappropriate (i.e., touching, laughing inappropriately) with staff and walking out of classBIP Behavior 3

For each 30-minute time period, circle the letters corresponding to the BIP components that were implemented:A-Prevention Strategies B- Teaching Strategies C-Response Strategies D-Crisis Intervention

Therapeutic Behavior Aide - Service LogStudent: DOB: School #: Student ID: Date: BIP Implemented by

TBA? (Y/ N)Time: Activity/Location Behavior 1 Behavior 2 Behavior 3 BIP Components 15 min 15 min

7:30-8:00 A B C D 8:00-8:30 A B C D 8:30-9:00 A B C D 9:00-9:30 A B C D

9:30-10:00 A B C D 10:00-10:30 A B C D 10:30-11:00 A B C D 11:00-11:30 A B C D 11:30-12:00 A B C D 12:00-12:30 A B C D 12:30-1:00 A B C D 1:00-1:30 A B C D 1:30-2:00 A B C D 2:00-2:30 A B C D 2:30-3:00 A B C D 3:00-3:30 A B C D 3:30-4:00 A B C D

Supervisor: Signature: Title: Aide: Signature: Total Y’s

Date: BIP Implemented by TBA? (Y/ N)

Time: Activity/Location Behavior 1 Behavior 2 Behavior 3 BIP Components 15 min. 15 min.7:30-8:00 A B C D 8:00-8:30 A B C D 8:30-9:00 A B C D 9:00-9:30 A B C D

9:30-10:00 A B C D 10:00-10:30 A B C D 10:30-11:00 A B C D 11:00-11:30 A B C D 11:30-12:00 A B C D 12:00-12:30 A B C D 12:30-1:00 A B C D 1:00-1:30 A B C D 1:30-2:00 A B C D 2:00-2:30 A B C D 2:30-3:00 A B C D 3:00-3:30 A B C D 3:30-4:00 A B C D

Supervisor: Signature: Title: Aide: Signature: Total Y’s

BIP Behavior 1

BIP Behavior 2

BIP Behavior 3

For each 30-minute time period, circle the letters corresponding to the BIP components that were implemented:A-Prevention Strategies B- Teaching Strategies C-Response Strategies D-Crisis Intervention

TBA Service Log Instructions:

The Service log should be completed by the TBA for each day the student is in attendance.

The Related Services Clinician who is counseling the student should individualize the template: Add up to three problem behaviors from the student’s BIP; Add the student’s individual class schedule, by subject, on the left- hand side in thirty minute

increments.

BIP components will be reviewed during the initial meeting between the TBA and the supervising Clinician to:

Enable the TBA to circle the appropriate intervention being provided to the student and to achieve accuracy in reporting;

Enable understanding of the student’s unique A-Prevention, B-Teaching, C-Response, and D-Crisis Intervention strategies.

For each thirty minute segment on the left side of the form the TBA will: Conduct a frequency count of the number of times each problem behavior occurs; Circle which interventions he/she provided during that segment of time.

For each 15 minute interval on the right side of the form, the TBA will: Indicate “Yes” if they used interventions A through C; Indicate “No” if they used D-Crisis Intervention which cannot be billed; “No” is also used during times the TBA is not directly servicing the child or any time the student

and TBA are not together. This may include the student’s lunch period, the Aide’s lunch period, the student’s individual or group therapy, field trips, and resource classes unless the Aide accompanies the student;

Count the ‘Yes’ responses and put the number in “Total Y’s”. This represents the number of 15-minute increments that can be billed.

Signatures are mandatory where indicated. Each month, the supervising Clinician sends the signed and completed Service Logs and Supervision Log to Third Party Billing, while retaining a copy for his/her records.

THERAPEUTIC BEHAVIOR INTERVENTION AIDE (TBA) SUPERVISION LOG 2017-18

Student: ______________________________ Pif: ______________ DOB: _____________ School: _________

TBA/Agency: _________________________ Supervisor: ________________________ *Credentials: ____________

Date of Current BIP: _______________ Date of Current IEP: _______________

Check Areas Discussed this Session Areas of Concern Action Plan with Tasks and Due DatesAdministrative: Attendance/Dependability

Focused/ Attentive (not on computer, cell phone)

Effective communications with student and staff

Clinical: Implementation issues

FBA and BIP components

Prevention, intervention, and response strategies

Trends in TBA logs

Student’s progress, needs, and fading of support

Contribution to team discussions

Classroom dynamicsSupport: Job-related stressors

Communication with Supervisor

Training and job knowledge

Self-awareness

Supervisor’s Signature: ________________________ Aide’s Signature: __________________________ Date: ________________

* A Licensed Psychologist, Licensed Clinical Social Worker, Licensed Physician or Authorized Practitioner pursuant to Health Occupations Article, Annotated Code of Maryland.

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