Medicaid Consortium - Direct Service Administrative Resources · 2017-09-05 · The student must...

800-221-MSBA(6722) [email protected]

2100 I-70 Drive Southwest Drive Columbia, MO 65202 www.mosba.org

Medicaid Consortium Connecting Students to Healthy & Bright Futures

Administrative Guidelines for

Direct Service Claiming

Table of Contents

Rules and Statutes 3

Introduction 3

Claiming Options 3

Getting Started 4

TL News & News Alerts 5

Step-by-Step Instructions 5

Update and Revision Information

for Billing 10

Billing & Revenue Record 15

Administrative Monitoring 18

District Audit File 22

Annual Administrative Responsibilities

for MHD Reporting 23

Appendix

1 MHD References 25

2 SLP Credentialing 26

3 School Based Direct Services 28

4 Legal Requirement for Scripts 29

5 Hearing Aid 30

6 Behavioral Health Services 33

7 Evaluation and Re-Eval Billing 34

8 eMomed Website 35

9 Step-by-Step Guidance for Accessing

Reports 41

10 Therapylog.com Reports 42

11 Updating Provider Information 47

© 2013 MSBA Medicaid Consortium 3

Rules and Statutes In Missouri, the State Medicaid agency is called MO HealthNet Division (MHD). It is under the Department of Social Services. The Direct Service Claiming guidelines set forth in this document are based on the requirements as outlined in MO HealthNet Provider Manuals, MO HealthNet Provider Bulletins and the Code of State Regulations (CSR). MSBA strongly encourages you to familiarize yourself with these documents. Throughout this document, text from the MO HealthNet Provider Therapy Manual will be set in text boxes for your reference.

See Appendix 1: MHD References

Introduction MSBA Medicaid Consortium offers an innovative, comprehensive, web-based billing system that eliminates duplication of paperwork for therapists and provides a data specific management option for administrators. The system can be used for MO HealthNet billing only or as a secure, comprehensive, database for therapy and lesson plan documentation. It serves as a compliance check for reimbursement guidelines and as a convenient web-based tool for scheduling and tracking individual students and/or groups of students and their progress.

Claiming Options MSBA Medicaid Consortium offers two web-based claiming options to fit the specific needs of individual districts—Option 1: Simple Billing and Option 2: Simple Management.

1. Simple Billing is a MO HealthNet therapy logging program that allows therapists to enter required billing information (i.e. time spent in therapy session, diagnosis code and service code) into a web-based form similar to that required on a paper billing log. This option does not allow for therapy notes to be entered into the software system, so therapists are responsible for writing, signing and maintaining therapy notes in a separate medical record for each student. In case of an audit, the billing records that are entered for each session into MSBA’s Medicaid software will need to be paired with therapy notes to validate that all required documentation was completed at the time of the service and is present in the child’s medical record. Therapist responsibilities include building a caseload and entering and editing billing information. Billable transactions are automatically uploaded to MHD and payment to districts occurs approximately twice a month. Administrators are able to generate reports showing the frequency that sessions are billed and the revenue generated by those sessions. This information can be tracked according to therapists or students.

2. Simple Management is a comprehensive system for therapists to keep all their scheduling, lesson planning, data and therapy notes in one place. The system automatically retrieves the information required to file a claim for direct services. Special bonus features support therapists with data for IDEA planning and reporting; and allows for flexible management styles of data entry. Therapist responsibilities include building a caseload; entering and maintaining IEP goals in the system; creating a therapy schedule with user friendly copy features; entering lesson plans and therapy notes; and editing data, as necessary. A device equipped with a microphone allows therapists to dictate therapy notes into Therapylog.com. The therapy note can be signed by using a computer mouse or a stylus or finger on a touchscreen device. And as an added feature an electronic file can be uploaded to a student’s record in Therapylog.com. NOTE: Therapylog.com has an app for iPads that allows scheduling and documentation of students’ sessions without internet access. When internet access is available the stored data automatically populates to the web-based version of Therapylog.com. Another option within the app is a data tracker to easily record progress.

It is required by MHD that therapists sign all therapy notes. If the therapist does not sign the therapy note on their computer or device they will need to run a report titled Month-End Billing Documentation Record at the end of each month for every Medicaid eligible student on his/her caseload and sign each


service date. If therapists sign directly on a device their signature will be displayed on referenced report and can be maintained electronically. The record is to be signed and maintained in the student’s medical record for a period of 5 years. (See Section titled Administrative Monitoring) The therapist is able to generate a variety of reports through Therapylog.com, including such things as, student progress reports with data graphing features and minutes of service for a designated time frame. Reports may be generated on demand from Therapylog.com allowing administrators to monitor therapists’ lesson plans, therapy documentation and student progress. Administrators are able to generate reports showing the frequency sessions are billed and the revenue generated by those sessions.

Getting Started Therapylog.com Admin Tab Features/Functions MHD and IDEA both have claiming requirements that must be satisfied before a school district is ready to bill MHD for providing direct services. Requirements include the following:

Each student must be MO HealthNet eligible on the date a medical service is provided.

School districts must provide notification to parents of the district’s intent to access their child’s or parent’s public benefits (Medicaid/MO HealthNet) to pay for services under the IDEA

and annually thereafter.

School districts must obtain signed one-time parental consent. Consistent with the Family Educational Rights and Privacy Act (FERPA) and the IDEA Part B requirements the signed one-time written consent authorizes the school district to disclose a child’s personally identifiable information from education records to MO HealthNet Division (MHD), a contracted billing agent and/or a physician to obtain necessary documentation for billing purposes.

A student must have a current IEP authorizing the medical service(s) such as therapies.

The student must have an annual prescription for occupational therapy, physical therapy, or speech/language therapy, as applicable.

Behavioral Health Service requires Prior Authorization instead of a prescription. Three hours of evaluation and four hours of therapy may be billed before Prior Authorization has been received.

Both the district (the billing provider) and each therapist (the performing provider) must be enrolled with MHD as active MO HealthNet providers.

Therapylog.com has built these compliance checks into the software system, along with guidance and resources to be used by districts.

Log on at www.therapylog.com

http://www.therapylog.com/


Therapylog.com homepage (pictured above)- Under the Admin Tools tab, the first two buttons, District Configuration and SDAC Dashboard, are used for the School District Administrative Claiming (SDAC) program

and not the Direct Service Claiming Program.

TL News and News Alerts MSBA staff will provide administrators and providers with updates of new features, new regulatory information, maintenance downtime, system bugs, etc. by posting a “News Alert” to the Therapylog.com home page. The TL News Tab provides additional information regarding access and management of “News Alerts”.

Step-by-Step Instructions Direct Services Dashboard, Students, Therapists, Blackout Dates and Groups

and then

1. The following resources are provided to assist districts

DIRECT SERVICE SET UP - DS Program Options - DS Participation Checklist - DS Student Roster File - DS Therapist Roster - DS School/Building File - DS Caseload Builder File - DS Directions for Printing Draft MHD Applications with PINs - Dr. Max Burgdorf’s Vitae - Simple Billing vs Simple Management Comparison


DIRECT SERVICE ADMIN TRAINING - Simple Billing Training Document - Simple Management Training Document - Sample Month End Billing Documentation Report - Sample Comprehensive Record of Therapy - Initial Evaluation and Re-Evaluation Billing - Service Codes - MSBA Administrative Guidelines for Direct Service Claiming - Monitoring and Managing Direct Services - New PT Eval and Reeval APTA Guidelines - New OT Eval and Reeval AOTA Guidelines DIRECT SERVICE ADMIN VIDEOS TELEPRACTICE - Teletherapy Overview

ONE-TIME PARENTAL CONSENT

- New Annual Parental Notification Form (English) - New One-Time Parental Consent Form Option 1 (English) - New One-Time Parental Consent Form Option 2 (English) - New Annual Parental Notification Form (Spanish) - New One-Time Parental Consent Form Option 2 (Spanish) - MOHealthNet Q&A Parental Consent(NEW posted on 9/5/17) - OSER’s New Parental Consent Q&A - MSBA’s New One-Time Parental Consent PowerPoint EXPANDED DIRECT SERVICES

- Expanded DS Reference Guide - MO HealthNet School Based Service Behavioral Health Summary - MO HealthNet School Based Service Hearing Aid Summary - MO HealthNet School Based Service Private Duty Nursing Summary - MO HealthNet School Based Service Personal Care Summary

2.

To get started, MSBA will send the district a set of Direct Services Set-Up Files for the district to complete. The Direct Services Set-Up Files include a Student Roster, Therapist Roster, School File, and the Caseload Builder File. The Student Roster provides a listing of the district’s IEP students, which were initially loaded to Therapylog.com. The system allows you to enter new students and inactivate students directly in Therapylog.com to keep the district’s student file up-to-date, especially when student turnover is minimal. Continuous, on-going revision of student data will ensure an accurate MO HealthNet eligibility match and current student availability for therapists’ caseloads and billing records. Importing student data to Therapylog.com from an IEP software program can be easily implemented when coordinated by the district. Therapylog.com will retrieve student data supplied by the IEP system through a secure FTP site. This nightly data feed will add new IEP student data, update new IEP dates, update new goals; and if maintained by the IEP system, add/update new consent and prescription dates. This scheduled importing of student data will have a positive effect on unbillable transactions and in turn reduce the time spent by administrators to monitor unbillable transactions. The administrator will want to ensure that all of the necessary student information for the eligibility check is included. The student’s full name (as it appears on the student’s birth certificate) and date of birth needs to be accurate. The name, birth date and social security number, if available, are critical pieces of information MHD uses to match for eligibility within their database. At this time, it is also a

http://therapylog.typepad.com/direct_services_resources/MOHealthNet-QA-BW%20Parental%20Consent.pdf


good idea to enter a unique identifier for each student on the district’s Student Roster and for each student that is manually entered into Therapylog.com. Either the student’s district’s ID number or their state issued MOSIS number is adequate to help identify students within Therapylog.com. The process for adding and inactivating students is provided below. It is critical to inactive students when they are no longer receiving IEP related medical services in order to maintain an efficient and accurate student database and eliminate unnecessary student data processing in Therapylog.com. How do I add a new student? The administrator can email an updated Student Roster to a staff member of the MSBA Medicaid Consortium or add individual students at: Admin Tools Tab > Student Button > Add a new Student > Submit

Why would I make a student inactive? If a student transfers out of your district, graduates from public school or is found to be ineligible for special education and related services, the administrator can make the student inactive. An inactive student can be changed back to an active student by following the same procedure and clicking Make Active. Admin Tools Tab > Student Button > Make Inactive > Okay

How do I search for a student? Student search requires last name, comma, space, first name OR student’s district assigned ID/MOSIS in the Search Term field. Admin Tools Tab > Student Button > “All Students” box in upper left hand corner > Enter name or ID.MOSIS in Search Term box. NOTE: Filters for All, Active, Inactive student searches can be managed form the “Status” drop down option.

Why is it important to have a complete and accurate listing of students? Student MO HealthNet eligibility is automatically run weekly through Therapylog.com. On Thursdays eligibility is submitted for the previous month, and on Fridays eligibility is submitted for the current month. This means that accurate MO HealthNet eligibility is available every Monday. In order for new students’ eligibility to be checked, they need to be entered before Thursday morning 12:00 a.m. Best practice would be to add new students before Wednesday to have the most accurate MO HealthNet eligibility available the following Monday.

Can an IEP electronic software system interface with Therapylog.com to share student data? Yes. It is possible. MSBA has successfully completed this process with several IEP software systems, which store new student enrollment names, IEP dates, and goals. This software system interface can automate student data updates and improve the efficiency of work flow for both the direct services administrators and providers. Please notify MSBA if you have questions or are interested in this process.

3.

The completed Therapist Roster will be loaded to Therapylog.com and used by MSBA to process applications for the therapists, as needed. The district should include all therapists contracted with or employed by the district who will be using Therapylog.com to enter data for a MO HealthNet billing record. Therapists’ licenses do have expiration dates and therapists are required to update their license before the expiration date. The administrator should make it a practice to update Therapylog.com with the new expiration date each time a therapist provides the administrator with a copy of his or her new license for the district’s audit file. Each therapist must be an active MO HealthNet provider with a Missouri license or, in the case of Speech Pathologists, either a Missouri license or a DESE Certificate.


Important Notice for SLP’s Are you a practicing speech-language pathologist (SLP) without proper credentialing?

No one would intentionally jeopardize their good standing as an SLP; however, a number of SLP’s in Missouri who provide services to children in public schools are inadvertently in this position. If you have a DESE certification as an SLP (either initial 4 year or lifetime career continuous professional certificate) that is specified as Student Services Certificate in Speech-Language Pathology, your DESE certification is tied directly to your Missouri Speech-Language Pathology License. In other words, if you let your license lapse, your DESE certification automatically lapses as well, even though the certification is for a time certain period. That time period only applies as long as the license is valid.

There are several factors that add to the confusion surrounding this issue. First, the certification from DESE states a time period for which the certification is valid and does not give warning that this is only the case as long as the Missouri Speech-Language Pathology License is also valid. Secondly, this was not always the case. If other SLP’s within a school district have a DESE certification that specifies “Speech/Language Specialist Certification in Speech-Language Pathology” or “Speech Correction Certification in Speech-Language Pathology,” their certification is not tied to licensure and they can practice as properly credentialed SLP’s with DESE certification only (i.e. without a valid state license).

Only SLP’s with proper credentialing are eligible to provide SLP services in Missouri and when students are otherwise qualified to bill MoHealthNet for providing those services. According to regulations in the MO HealthNet Provider Manual, either an SLP with a valid DESE credential and/or a valid Missouri license that has applied and received a MO Medicaid number is an eligible MO HealthNet provider.

See Appendix 2: Credentialing of School Speech-Language Pathologists Frequently Asked Questions &

Answers (FAQ)

When the administrator adds a therapist, they should be sure to use the name as it appears on the therapist’s license/certificate, NPI and Medicaid provider records. Accurate information is critical - Any name or email address variance on the SDAC Personnel Roster will create a new record. NOTE: By regulation, a therapist must notify MO HealthNet Division when he/she has a legal name change or change in address. How do I add a new therapist? You can add new therapists at: Admin Tools Tab > Therapist Button > Add new Therapist > Submit

How do I make a therapist inactive? If a therapist is no longer contracted with or employed by the district he or she can be made inactive at: Admin Tools Tab > Therapist Button > Mark Inactive under the Action Heading

Can the DS Administrator view the therapists’ calendars, individual/group appointments and lesson plans? Yes. You can see a therapist’s calendar at: Admin Tools Tab > Therapist Button > Locate individual therapist in listing To the right of the therapist’s name click on “See Calendar” under the Action column. The current month will populate Select a different month by using arrows on the top of the calendar to move backward or forward To open and view a specific day on the therapist’s calendar click on the date number to open the day planner page You can then open and view individual/group appointments by clicking on the appointment AND from the day planner page you can create, view, and print a Detailed Lesson Plan or Condensed Lesson Plan for that day


4. Dates that are "blacked out" block the repeat scheduling function for therapists. Blackout Dates for school holidays will eliminate the possibility of a therapist inadvertently scheduling therapy on a day school is not scheduled to be in session. The use of the Blackout Dates Button is optional.

5. Reports can be generated for an identified group of therapists. For example, an administrator could form a group that includes all PTs, OTs or SLPs; or ECSE providers or therapists supervised by a single coordinator. The use of the Groups Button is optional.


Update and Revision Information for Billing

The Direct Services Student Roster is used to run student MO HealthNet eligibility through the MHD database. Those students from your district that are MO HealthNet eligible will display in “yellow” in Therapylog.com. Once the MO HealthNet eligibility match has been completed, therapists can be trained to use Therapylog.com and enter their billing records. Therapylog.com can then batch all of the transactions that meet billing requirements and submit them to MHD for processing. What are the billing requirements that qualify a transaction for billing?

The student must be MO HealthNet eligible on the date the service was provided.

The student must have a current IEP with the services to be billed documented in the IEP.

In accordance with federal law, school districts must provide notification to parents of the district’s intent to access their child’s or parent’s public benefits (Medicaid/MO HealthNet) to pay for services under the IDEA prior to obtaining a one-time parental consent and annually thereafter.

The school district must obtain a one-time parental consent to submit claims to MO HealthNet. Consistent with the Family Educational Rights and Privacy Act (FERPA) and the IDEA Part B requirements, the signed one-time parental consent authorizes the school district to disclose a child’s personally identifiable information from education records to MO HealthNet Division (MHD), a contracted billing agent and/or a physician to obtain necessary documentation for billing purposes.

Each year, there must be a physician’s prescription for each therapy service billed to MO HealthNet (OT, PT, and Speech/Language).

Behavioral Health Service requires Prior Authorization instead of a prescription. Three hours of

evaluation and four hours of therapy may be billed before Prior Authorization has been received.

The therapist providing the service must have current licensure or certification, as applicable.

The therapist must be an active MO HealthNet provider.

The district (billing provider) must be an active MO HealthNet provider.

The transaction must be a MHD approved billable service.

The district must create an eMomed account at www.eMomed.com whether the district plans to bill through the MHD portal or through a billing agent, like MSBA Medicaid Consortium.

See Appendix 3: School Based Direct Services

Billing Requirements for Students: IEP Date, One-time parental consent, and Prescription 1. IEP Date

IEP dates need to be accurate. In order to bill for a student, the district must have documented in Therapylog.com a current IEP date that verifies at the time of service the student had a valid IEP, which is the “Plan of Care” under MO HealthNet regulation. To ensure that services are not billed without a current IEP in place, Therapylog.com checks the IEP date entered in the system by the district and will not submit for billing to MHD any transactions for students without a documented IEP or with an expired IEP. Failure to keep IEP information current in Therapylog.com may unnecessarily delay billing and receipt of revenue by the district.

How do I change IEP/Reeval dates in Therapylog.com? You can update/revise a student’s IEP date at: Admin Tools Tab > Student Button > Click IEPs > Click Add New IEP button > Click in IEP Date Box > Enter month/date/year or select date from calendar > Save NOTE: Reevaluation dates can be changed using same process.

http://www.emomed.com/


2. One-Time Parental Consent and Prescription One-time parental consent and prescriptions are requirements for billing MO HealthNet services under the IDEA and Medicaid laws, respectively. The district can choose either to have Therapylog.com track one-time parental consents for the district or not. If the district chooses to have Therapylog.com track compliance with one-time parental consent, documentation must be entered into Therapylog.com before transactions will be submitted to MHD for payment. If your district chooses to NOT have MSBA maintain records of compliance for one-time parental consent, the district’s Direct Services Coordinator must provide MSBA Medicaid Consortium with a written request to turn off the one-time parental consent tracking feature. Your district would then be responsible for keeping track of which parents have and have not provided the necessary written consents. The district maintains the actual one-time parental consent documents in either case.

According to MHD, in order for Physical Therapy and Occupational Therapy to be billed to Medicaid, a MO HealthNet enrolled primary care provider must prescribe physical and occupational therapy evaluation and therapy treatment services. Speech/language evaluation and therapy treatment services require a signed, written referral by a MO HealthNet enrolled primary care provider. Letters or prescriptions signed by a primary care provider are examples of acceptable written referral for speech/language services. Referrals or prescriptions must include the primary care provider's National Provider Identifier (NPI) number. Medicaid will also accept scripts signed by a Nurse Practitioner. Scripts and letters of referral are valid for one year. According to training material prepared by MO HealthNet and DESE, school districts should make every attempt to obtain the prescriptions from the child’s primary care provider. If it is not possible to obtain the prescription from the child’s primary care provider, the district may obtain a prescription from a MO HealthNet enrolled primary care provider. Districts should be mindful that pursuant to FERPA, parent/guardian permission to release information must be received prior to sharing an evaluation summary and IEP with a physician.

See Appendix 4: When Are Scripts Legally Required? Who Can Legally Make a Diagnosis?

Prescriptions must be tracked through Therapylog.com. If a child does not have a primary care physician (PCP) or the district is not able to obtain a prescription from the PCP, MSBA is able to assist the district with obtaining the prescription. In this case, the dates of the OT and ST prescriptions will be entered into Therapylog.com by the prescribing physician as part of the service. Prescriptions for OT and ST services obtained by the district must be documented in Therapylog.com by the district before the claims will be submitted to MHD for payment. As PT prescriptions are required to provide services under PT licensure, a pop-up window will appear before the first service is submitted in Therapylog.com for each student receiving PT services each school year. The pop-up asks the PT to confirm that a prescription is in place. Confirmation will allow billing to move forward. At the beginning of each new school year, Therapylog.com will set the default date on August 1st of the current year to one year from that date. Beginning and ending dates for prescriptions can be changed by clicking in the date box and selecting a month, date and year from the calendar or by entering the date in the box. As of March 18, 2013, federal requirements under IDEA were amended and new regulations regarding one-time parental consent requirements went into effect. The effective date of the one-time parental consents can be entered in the same manner as prescription dates are entered. NOTE: Do not remove (delete) prior years’ parental consent and prescription dates. This information serves as the district’s running record for audit purposes.


How do I document One-time Parental Consents? You can document receipt of signed One-time Parental Consents at: Admin Tools Tab > Student Button > Edit > New Parental Consent (in blue) >Choose “One-Time” from drop down box and enter begin date > Submit.

How do I indicate that a parent did not return the One-time Parental Consent or indicated refusal of consent? You can document when a parent does not respond or indicates refusal to give One-time Parental Consent at: Admin Tools Tab > Student Button > Edit > Uncheck box ‘parent consent granted?’ > Submit.

How do I add prescriptions each year? You can enter the effective date(s) from the paper copies of physician signed prescriptions at: Admin Tools Tab > Student Button > Edit > New prescription (in blue) > Submit.

3. Two Types of Prescription Batches 1. District Obtained Prescriptions: Therapylog.com can create a batch of printable prescriptions that

the district can provide to the student’s physician for signature. These printable prescriptions will be generated as a report posted to the home page and sent as a link to your email. It is important that caseloads are current as these prescriptions are based on caseload assignments, with the exception of PT prescriptions. There is no additional charge for this report.

How do I generate a printable prescription batch? You can create a report of printable prescriptions at: Admin Tools Tab > Student Button > Generate prescriptions in batch Select All Students by clicking “Go” OR Check boxes next to individual student names Action will remain “Generate Printable Prescriptions” ”Effective Date” can be changed by clicking in the date box Enter physician’s name and NPI (optional) > Click “Execute”

NOTE: THIS LIST ONLY CONTAINS MEDICAID ELIGIBLE STUDENTS WHO ARE ON A CASELOAD, ACTIVE IN THE DISTRICT

ROSTER, WITH PARENTAL CONSENT AND WHO DON'T HAVE A CURRENT PRESCRIPTION.

2. MSBA Assisted Prescriptions: Therapylog.com creates an electronic prescription batch that is

accessible to MSBA should a district need assistance obtaining one or more prescriptions, with the exception of PT prescriptions. Before requesting the electronic prescription batch, the district must first upload the pdf files of each student’s current IEP with IEP initiation date and most recent evaluation or re-evaluation summary report for the requested prescriptions. For each child requiring one or more prescriptions, a MO HealthNet enrolled primary care provider will review the current IEP and most recent evaluation summary report(s) and complete a signed paper prescription, as deemed appropriate. Prescriptions will be documented in Therapylog.com as part of the service and a pdf copy of the original paper prescription, which is signed by a MO HealthNet enrolled primary care provider, will be posted in the student’s account in Therapylog.com. The prescription can be maintained in electronic or paper for audit purposes, If the district would like a paper copy of the prescription they can download and print a copy from the student account. A district must contact MSBA to make arrangement for this service.

How do I request an electronic prescription batch? 1. Upload the current IEP and most recent evaluation or re-evaluation summary report documents in pdf format at:

Admin Tools Tab > Student Button > Locate Student Name in List > On the far right of the Student Name line click on “Upload IEP” > Click “Browse” and locate the pdf IEP file on your computer > Click on the file name > The file name will appear in the box next to “Browse” > Click “Upload” and add IEP initiation date in the “Effective Date” box. Follow the same procedure to “Upload Most Recent Evaluation”. No date is required for Evaluation.


2. Request an electronic prescription batch: Admin Tools Tab > Student Button > Generate prescriptions in batch Select All Students by clicking “Go” OR Check boxes next to individual student names Change Action with drop down box to “Send Prescriptions to MSBA” “Effective Date” can be changed by clicking in the date box Type district contact information as specified in “Contact and Mailing Information for Scripts” > Click “Execute”

NOTE: THIS LIST ONLY CONTAINS MEDICAID ELIGIBLE STUDENTS WHO ARE ON A CASELOAD, ACTIVE IN THE DISTRICT

ROSTER, WITH PARENTAL CONSENT, WITH IEP AND EVAL/REEVAL DOCUMENTS UPLOADED AND WHO DON'T HAVE A

CURRENT PRESCRIPTION.

13.10 PRESCRIPTION FOR PHYSICAL AND OCCUPATIONAL THERAPY SERVICES

A MO HealthNet-enrolled primary care provider must prescribe physical and occupational therapy evaluations and therapy

treatment services. The prescription must include the primary care provider's National Provider Identifier (NPI) number.

The prescription is valid for a maximum period of one (1) year. A new prescription for physical therapy or occupational therapy

services must be obtained from the provider each year if services are to continue.

13.11 REFERRAL FOR SPEECH THERAPY SERVICES

Speech/language evaluations and therapy treatment services require a referral by a MO HealthNet-enrolled primary care provider.

A referral must be provided in written format and signed by the provider. The referral must include the primary care provider's

National Provider Identifier (NPI) number.

The written referral is valid for a maximum period of one (1) year. A new written referral for speech therapy services must be

obtained from the provider each year if services are to continue. Letters or prescriptions signed by the primary care provider that

include the primary care provider's NPI number are examples of acceptable written referral for speech/language services.

MO HealthNet Provider – Therapy Manual, Section 13

13.12 PLAN OF CARE

A provider-signed plan of care must be maintained at the facility where services are performed and must be made available for

audit purposes at any time. The MO HealthNet Division does not require a specific form for the plan of care.

The Individualized Education Plan (IEP), Individualized Family Service Plan (IFSP) or other comprehensive treatment plan

developed for a specific child may serve as a plan of care for a child receiving physical therapy (PT), occupational therapy (OT)

and speech therapy (ST) services under the HCY Program. PT, OT and ST services are considered IEP or IFSP therapy when they

are:

• included in an Individual Education Plan (IEP) as defined by the Individuals with Disabilities Education Act, Part B (34

CFR 300 and 301); or

• included in an Individualized Family Service Plan (IFSP) as defined by the Individuals with Disabilities Education, Part

H (34 CFR 303) Early Intervention Program for Infants and Toddlers with Disabilities.

Services must be provided as indicated in the plan of care.

A participant’s plan of care must be evaluated at regular intervals within standard medical practice guidelines.

The plan of care must specify:

• diagnosis;

• desired outcome;

• nature of the treatment;

• frequency of treatment (number of minutes per day/per week/per month); and

• duration (weeks or months) of services.

The participant may not be charged for development of the plan of care. MO HealthNet does not reimburse the provider to

participate in IEP or IFSP meetings when developing a plan of care for a child.



13.12.A Individual Education Plan (IEP)/Individualized Family Service Plan (IFSP)

Providers billing for PT, OT or ST services for an IEP are required to maintain a copy of the official public school generated IEP

in the participant’s record to document the service as an IEP service. Only PT, OT and ST services identified on an official IEP

generated by the public school, regardless of whether the child attends a public or private school, are reimbursed by MO

HealthNet.



Billing and Revenue Record Billing Requirements for Therapists: Current MO License or DESE Certification (Speech Therapists only), NPI number (if required) and active MO HealthNet Provider Status All licensed certified providers must have a NPI number and active MO HealthNet provider status. MSBA will assist districts to complete the applications. In order for Therapylog.com to submit transactions to MHD, the provider must have a NPI number that has been enrolled with MHD and documented in Therapylog.com under the Admin Tools Tab, Therapist Button. A provider must also have a current license or DESE certificate, as applicable, to be eligible to bill MHD. How do I update therapist’s information (i.e. license, NPI, Medicaid information)? You can enter updated/revised therapist information at: Admin Tools Tab > Therapist Button > Edit under the Action Heading > Submit

Training Requirement All therapists using Simple Billing or Therapy Management in Therapylog.com will require training the first year and refresher training, as needed. The training will be completed by MSBA Medicaid Consortium staff on site at the district or via webinar at no additional cost to the district.

Therapylog.com, if used as a Therapy Management tool, will allow therapists to enter non-billable

activities on their calendar, so they can track all of their therapy sessions and appointments in one place. However, Therapylog.com will only release the following services for billing:

13.3 THERAPIST PROVIDER PARTICIPATION REQUIREMENTS To participate in the MO HealthNet Therapy Program, the therapy provider must satisfy the following requirements:

• Physical Therapist—a person currently licensed by the state of Missouri as a physical therapist.

• Occupational Therapist—a person currently licensed by the state of Missouri as an occupational therapist.

• Speech Pathologist—a person currently licensed by the state of Missouri as a speech pathologist.

• Speech/language therapist providing services as an employee of a public school—a person certified by the state

Department of Elementary and Secondary Education.

A speech/language therapist qualifying as a provider due to certification from the Department of Elementary and Secondary

Education (not licensed by the State of Missouri) may provide services only to children that are served by the school district.

Additional information on provider conditions of participation can be found in Section 2 of the Therapy Provider Manual.

2.1 PROVIDER ELIGIBILITY

To receive MO HealthNet reimbursement, a provider of services must have entered into, and maintain, a valid participation

agreement with the MO HealthNet Division as approved by the Missouri Medicaid Audit and Compliance Unit (MMAC).

Authority to take such action is contained in 13 CSR 70-3.020. Each provider type has specific enrollment criteria, e.g., licensure

certification, Medicare certification, etc., which must be met. MO HealthNet Provider – Therapy Manual, Section 13 and Section 2


OT/PT SERVICES SPEECH/LANGUAGE SERVICES

EXPANDED SCHOOL BASED SERVICES

Therapeutic Exercises 97110

Neuromuscular Re-Education 97112

Therapeutic Activities 97530

Cognitive Skills Development 97532

Sensory Integration 97533

Self Care Management Training 97535

Gait Training 97116

Manual Therapy 97140

Orthotic Training 97504

Prosthetic Training 97520

Wheelchair Management/Propulsion Training

97542

Speech/Language Therapy - Individual 92507

Speech/Language Therapy - Group 92508

Eval of speech sound production 92522

Eval of speech fluency 92521

Eval of speech sound production w/ eval of lang comprehension and expression

92523

Behavioral and qualitative analysis of voice and resonance (For services on or after 01/01/14)

92524

Eval for Prescription of Speech-Generating AAC Device, First Hour

92607

Eval for Prescription of Speech-Generating AAC Device, 30 Additional Minutes

92608

PT Evaluation (High) 97163

PT Evaluation (Moderate) 97162

PT Evaluation (Low) 97161

OT Evaluation (High) 97167

OT Evaluation (Moderate) 97166

OT Evaluation (Low) 97165

Private Duty Nursing T1000

Personal Care T1019

Hearing Aid (Audiology) See Appendix 5

MO HealthNet Behavioral Health See Appendix 6

13.14.D THERAPY EVALUATION SERVICES

Evaluations for physical, occupational, and speech therapy do not require prior authorization.

Four (4) hours of evaluation per discipline for a child (per provider) are covered within a twelve month period.



See Appendix 7: Evaluation and Re-Evaluation Billing

13.14.E THERAPY TREATMENT SERVICES Therapy treatment services that may be billed to MO HealthNet are treatment services provided directly to the patient by the

therapist.

Physical, occupational and speech therapy treatment services that exceed one (1) hour and fifteen minutes or five (5) hours

weekly are intensive therapy treatment services and require that the provider document the medical necessity of the intensive

therapy treatment service(s).

When billing one (1) hour and 30 minutes (6 units) or more of therapy per day or more than five (5) hours (21 or more units)

of therapy per week, the provider must have documentation that justifies the need for intensive therapy services. The

following documentation must be available for each date of service that exceeds the limitations:

• the therapy current evaluation;

• the treatment plan (plan of care), specify frequency and duration; and

• for physical or occupational therapy, a MO HealthNet-enrolled primary care provider's prescription; or

• for speech/language therapy, a MO HealthNet-enrolled primary care provider's written referral.

All documentation for intensive therapy treatment services are not required to be submitted with the claim. The

documentation as outlined in the Therapy Provider Manual must be kept in the medical record and shall be provided to the

MO HealthNet Division upon request. The MO HealthNet participant or participant's family cannot be billed for the units of

service that are NOT considered medically necessary.



Billing Process, Remittance Advices and Payments The billing process begins with providers entering transactions in the system. Once a transaction has been completed and the provider has approved the service, that service will wait for three days and then be compiled into a billing batch to be submitted to MHD. Within that three day period, the provider has the ability to change any of the details of the service. Once the service becomes a part of a billing batch, any adjustments to the claim will need to be made after payment. Claim batches are sent to MHD every two weeks according to the MO HealthNet “Claims Processing and Payment Schedule”. Monday after each billing cycle, the MO HealthNet Remittance Advices (RAs) will be posted on the eMomed site. The paid amounts will be listed and a Generate Summary Report will be available for viewing on Therapylog.com. Checks associated with given RAs follow two weeks after the payments are listed. There are two ways to access RAs associated with each payment from MO HealthNet;

1. The administrator can access the District’s RAs directly through the MO HealthNet website www.eMomed.com by logging in, clicking on “File Management” and scrolling to the link that reads “Printable RA”.

2. RA’s may be accessed through Therapylog.com: Admin Tools Tab > Direct Services Button > Payment Button. The last ten payments will be listed. To the right of the payment amount you will be able to click Generate Summary showing all of the transactions that comprise that payment

See Appendix 8: How to use eMomed to check Student eligibility and Locate RAs

Administrative Monitoring

Monthly/Quarterly Recommended Reports In order to maximize the amount of revenue coming into the district through direct services billing, it is important to check provider entries, unbillable appointments, and denied claims. MSBA recommends the District run a series of reports to analyze potential missed sources of revenue on a monthly basis and make the necessary corrections. In addition to the reports discussed in this section, the administrator can review therapists’ data entries and the status by viewing appointments. The appointments and status can be accessed from the Admin Tools Tab through the Therapists Button. After clicking on the Therapists Button, click on appointments to view details. The appointments can be sorted by student. The Status definitions are as follows:

Incomplete- Appointment needs to be documented.

Unsubmitted- Appointment has not been sent to MHD for various reasons.

Submitted- Appointment has been sent to MHD for billing.

Paid- Appointment has been paid by MHD.

Denied- Appointment has not been paid by MHD for various reasons.

Marked for resubmission- Appointment marked to be sent back to MHD because of denied status.

Resubmitted- Appointment has been sent to MHD because of denied status.

To be voided- Appointment paid by MHD in error. Claim to be sent back to MHD to be voided.

Voiding- Appointment has been sent to MHD to be voided.

Voided- Confirmation that appointment has been voided by MHD shows up on an RA.

http://www.emomed.com/


Therapist Entries It is important to check the number of therapists’ entries each month, especially when you notice that DS revenue seems to be low. This can be done by running a report called the Service Summary for Therapists. Below is an example of a Service Summary for Therapists report.

Understanding the Service Summary for Therapists Report To understand what this report is showing, keep in mind the time frame for the report that was generated. This report shows the number of MO HealthNet eligible (ME) students on each therapist’s caseload; the total transactions (i.e., number of student/ therapist sessions); the total number of minutes spent in sessions; and, the number of billable units generated by each therapist for the given time period. The real value of this report is to check and see if therapists are entering their appointments. If revenue is lower than expected, it is possible that some therapists are not entering appointments or therapists have not entered a complete month. Interpretation of the Service Summary for Therapists report example located above. This example represents a three month time period and uses the assumption that a therapist sees each Medicaid eligible student on his/her caseload twice a week. Certainly twice a week is not a hard and fast rule (the number of therapy sessions provided weekly can vary) but for the purposes of interpreting this report an average of twice a week has been used. The reported data for Therapist #1 (Column A) indicates a caseload with 8 Medicaid eligible students (Column C). If Therapist #1 sees each of the 8 Medicaid eligible students twice a week for 12 weeks (8 students x 2 times weekly x 12 weeks = 192 therapy sessions) an expected ballpark figure for therapy sessions would be 192. The actual number of therapy sessions entered into Therapylog.com by Therapist #1 is 100 (Column E), which would indicate that Therapist #1 has entered about half of the potential therapy sessions.

Column D represents the number of Medicaid eligible students with a signed one-time parental consent. Therapist #1 has 3 of the 8 Medicaid eligible students with consents. This would not affect his/her entry of therapy sessions. Once Therapylog.com is updated with the consent date those therapy sessions held for no consent will be processed for billing.

Column F represents the number of undocumented therapy sessions - 0 for Therapist #1.

Column G represents the total number of minutes (4625) provided by Therapist #1 during the 100 therapy sessions.

Column H represents the total number of Medicaid billable units (308) for the 100 therapy sessions provided by Therapist # 1.

192 600 408 912

675


*See expected ballpark figures for Therapist #2, Therapist #3, Therapist #4 and Therapist #5 in red under Column K in the example report above. NOTE: The Service Summary for Therapists report generated from Therapylog.com will not include expected ballpark figures in Column K. These are included on this report for interpretation purposes only. Therapist #5 has entered 613 therapy sessions, with an expected ballpark figure for potential therapy sessions of 675. This would indicate that Therapist #5 is doing a good job of entering therapy sessions for Medicaid billing. Unbillable Transactions The Students: Unbillable Transactions and the Therapists: Unbillable Transactions reports show clearly how much revenue is pending due to unbillable transactions. They clearly indicate which students, therapists or transactions need adjustments and how to make corrections in order for these transactions to be submitted for billing. These reports filter out any transactions that are unbillable but not fixable, like entries made for a student that is not MO HealthNet eligible. The result is an accurate representation of your unbillable transactions. These reports are an excellent place to start when trying to understand where the district can increase the amount of money coming from MO HealthNet billing. Use the Trouble Shooting Unbillable Reports, a reference guide, to identify specific recommendations to resolve the problem(s).

Therapist Documentation In MHD’s Therapy Manual it states, “All services provided must be adequately documented in the [student’s] medical record.” According to MHD, documentation of each session must be initialed and each page signed by the rendering provider. The Month-End Billing Documentation Record, when printed and signed by the providing therapist, meets the regulatory requirement for documentation of the therapy record for audit purposes. This document is important to ensure that the district is audit ready at any time.


The Month-End Billing Documentation Record should be printed each month for each student on a therapist’s caseload that was MO HealthNet eligible for all or any part of the month. This report contains fields for all of the MO HealthNet requirements for adequate documentation that must be maintained in the student’s medical record for five years after the date of service. This is the report therapists use to meet the requirement that each therapy session must be signed by the providing therapist. Note for Simple Billing: Therapists utilizing Simple Billing may print, sign, and attach written therapy notes to this monthly report to meet adequate documentation requirements. New technology, such as the iPad, will allow therapists to sign directly on the iPad surface, no longer requiring this report to be printed monthly. Signatures on the iPad at the time of therapy documentation will be maintained on the electronic report for audit purposes. The Comprehensive Record of Therapy is a supplemental report to the Month-End Billing Documentation Record that will include additional documentation of data therapists entered into the Therapylog.com to support the monthly signed document. The Comprehensive Record of Therapy contains all information entered by a therapist into Therapylog.com regarding individual student’s therapy sessions in an easy-to-read, well-organized manner. The report is designed to be a complete back-up record to the Month-End Billing Documentation Record, and as such, can be maintained electronically. Administrators can use this report as a review of lesson plans and outcomes. Therapists are encouraged to use this report for any purpose and in any manner deemed beneficial in the IEP process or in case of an audit review. See Appendix 9: Step-by-Step Guidance for Accessing Reports See Appendix 10: Therapylog.com Report Descriptions

2.3.A ADEQUATE DOCUMENTATION

All services provided must be adequately documented in the medical record. 13 CSR 70-3.030, Section (2)(A) defines “adequate

documentation” and “adequate medical records” as follows:

Adequate documentation means documentation from which services rendered and the amount of reimbursement received by a

provider can be readily discerned and verified with reasonable certainty.

Adequate medical records are records which are of the type and in a form from which symptoms, conditions, diagnoses,

treatments, prognosis and the identity of the patient to which these things relate can be readily discerned and verified with

reasonable certainty. All documentation must be made available at the same site at which the service was rendered.


13.4 SPECIAL DOCUMENTATION REQUIREMENTS

For physical, occupational and speech therapy services, the MO HealthNet Division requires that the following documentation be

included in the recipient’s medical record:

• Participant’s complete name;

• Participant’s date of birth;

• Date service was provided;

• actual treatment provided for the participant (more than “treatment given”) on the specific date of service;

• individual or group therapy;

• the setting in which the service was rendered;

• time service was delivered (e.g., 4:00-4:15 p.m.);

• The name, title, and signature of the therapist who provided the service;

• the plan of care must include treatment, evaluation(s), test(s), findings, results, and prescription(s)/referrals;

• documentation for the need of the service(s) in relationship to the participant's treatment plan;

• The participant's progress toward the goals stated in the treatment plan; and

• official Individualized Education Plan (IEP) or Individual Family Service Plan (IFSP) when billing therapy services

documented in an IEP or IFSP. MO HealthNet Provider – Therapy Manual, Section 13


District Audit File

The administrator will want to have Direct Service audit files for OT, PT, and Speech/Language Therapy that contain the MHD and IDEA requirements listed below: Student Medical Record (electronic or paper file) should contain:

IEP(s), Evaluation Report(s)

Documentation of provision of annual notification of intent to bill Medicaid (IDEA)

One-time Parental Consent (IDEA)

Annual Prescription

Therapy Notes, including all required documentation related to the therapy session and specified billing information, for each service date signed by the Providing Therapist. NOTE: Month-End Billing Documentation Record satisfies this requirement for Simple Management Users

Individual Therapist’s Files and District Files should contain:

NPI number

Medicaid number and/or approval letter

Copy of MO HealthNet application; if available

Copy of license or DESE certification (SL therapist only)

Any communication with MHD

2.3 RETENTION OF RECORDS

MO HealthNet providers must retain for 5 years (seven years for the Nursing Home, CSTAR, and community psychiatric

rehabilitation programs), from the date of service, fiscal and medical records that coincide with and fully document services billed

to the MO HealthNet Agency, and must furnish or make the records available for inspection or audit by the Department of Social

Services, Missouri Medicaid Audit and Compliance Unit, or its representative upon request. Failure to furnish, reveal and retain

adequate documentation for services billed to MO HealthNet may result in recovery of the payments for those services not

adequately documented and may result in sanctions to the provider’s participation in the MO HealthNet Program. This policy

continues to apply in the event of the provider’s discontinuance as an actively participating MO HealthNet provider through

change of ownership or any other circumstance.



Annual Administrative Responsibilities for MHD Reporting The administrator will want to complete the MHD reporting requirements as needed throughout the year to satisfy the 5-day notification by certified mail required for changes in provider information. Providers should notify MMAC of changes, such as a change in a provider’s last name, address, etc. by completing the “Provider Update Request” form. This form is referenced in MO HealthNet Provider ‘Hot Tip of the Week’ for March 10, 2014 Provider Addresses Must Be Kept Current’. A copy of the required form can be found in Appendix 10. This form must be completed and submitted via fax to 573/634-3105.

See Appendix 10: Provider Update Request Form

2.2 NOTIFICATION OF CHANGES

A provider must notify the Provider Enrollment Unit within five (5) days by certified mail of:

• Change of provider address. This is necessary to ensure that all checks and correspondence are received promptly.

Indication of change of address on a claim form is not sufficient.

• Change of ownership of business. A new participation agreement is required.

• Change of Licensure.

• Change of direct deposit information.



Appendix


Appendix 1: MHD References Therapy Manual: http://manuals.momed.com/manuals Occupational, Physical and Speech Therapy School Based Services Bulletin dated 11/30/10: www.dss.mo.gov/mhd/providers School Based Services Bulletin (8/24/10): www.dss.mo.gov/mhd/providers

Code of State Regulations, 13 CSR 70-3: http://www.sos.mo.gov/adrules/csr/current/13csr/13c70-

3.pdf

http://manuals.momedcom/manuals

http://www.dss.mo.gov/mhd/providers

http://www.dss.mo.gov/mhd/providers


Appendix 2: Credentialing of School Speech-Language Pathologists Frequently Asked Questions and Answers (FAQ)

1. What credentials are available to school Speech-Language Pathologists (SLPs)?

There are two credentials that can be issued to school Speech-Language Pathologists –

Missouri Speech-Language Pathology License: This credential is issued by the Board of Healing Arts. A Provisional License is issued to all individuals (usually new graduates) who have not yet completed 9 months of supervised work experience. An “unencumbered” License is issued once that nine month supervised period has been completed.

Student Services Certificate in Speech-Language Pathology: This credential can be issued by the State Board of Education through the Department of Elementary one of three ways – 1) by holding a valid, “unencumbered” Missouri SLP license from the Board of Healing Arts as described above; 2) by holding a Masters Degree in SLP, passing the Praxis test and having specific education coursework (about 18 hours) from a DESE approved professional education program or 3) through reciprocity.

2. What credential does an SLP working in the schools need?

The short answer is most likely they will need both an SLP License issued by the Board of Healing Arts (BHA SLP License) and then a “coupled” Student Services SLP Certificate issued by the State Board of Education (DESE SLP Certificate).

Currently, a DESE SLP Certificate is almost always issued based on the individual holding a valid BHA SLP License. In only very rare circumstances will an individual be eligible to directly receive a Department of Education certificate without holding Missouri licensure through the Board of Healing Arts. None of the Missouri SLP programs are DESE approved professional education programs and as a result all students graduating from Missouri SLP programs MUST first obtain their BHA SLP License and then obtain the DESE SLP Certificate secondary to the BHA SLP license. About the only individuals who are currently directly receiving a DESE SLP Certificate absent a BHA SLP License, are those from out-of-state who hold another state SLP “teaching certificate” using reciprocity.

3. What happens if a school district employs someone fully qualified who does not yet have their BHA SLP License (and thus no DESE SLP Certification) while their licensure application is being processed?

Missouri state law (RSMo. 345.025) prohibits anyone from practicing speech-language pathology without a Missouri license. The only exception in the law is for an individual who “holds a current valid certificate as a speech-language pathologist issued by the Missouri Department of Elementary and Secondary Education and who is an employee of a public school while providing speech-language pathology services in such school system.” A person working as an SLP in the schools without a valid BHA SLP license or DESE SLP certificate (current SLP Student Services, Speech Language Specialist or old Speech Correction Certificate) is violating state law and it will be difficult for them to obtain their BHA SLP license because they practiced in violation of the licensure law. This includes individuals who do have their Masters degree in SLP, have passed the Praxis, and may hold the Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA).


4. Is there any short-term DESE credential available while an individual is waiting for their BHA SLP licensure application to be completed?

No, the DESE Temporary Authorization Certificate (TAC) is only issued to those individuals who hold a Provisional SLP License from the Board of Healing Arts. It is important to remember that an individual MUST have either a BHA SLP License (Provisional or Regular) or a DESE SLP Certificate to work as an SLP in the schools. A TAC alone (without the Provisional License) does not satisfy the exemption requirement for a person to hold a DESE SLP Certificate, thus working with only a TAC as an SLP is a violation of the licensure law. 5. Does an SLP need to keep their BHA SLP Licensure current even after they receive their DESE SLP Certificate? Yes, when the DESE SLP Certificate is issued based on holding a BHA SLP License, the two credentials are forever linked. The DESE SLP Certificate is valid if the BHA SLP License is also valid.

6. What are the renewal requirements for the BHA SLP License?

The BHA SLP license must be renewed every two years. All BHA SLP licenses are issued in January of odd numbered years, so all are renewed at the same time. Thirty hours of continuing education must be obtained in each two year renewal cycle, of which a minimum of 20 hours must be provided by an approved organization such as DESE, Council for Exceptional Children or Missouri Speech-Language-Hearing Association. See http://pr.mo.gov/speech-rules-statutes.asp for more information.

7. What are the renewal requirements for the DESE SLP Certificate?

For those individuals who obtained their DESE SLP Certificate by holding BHA SLP Licensure, the renewal requirements of the BHA SLP License must be followed. The Initial Student Services Certificate (issued based on the full BHA SLP License) is valid for 4 years. DESE reviews the licensure registry to confirm that the individual is maintaining their BHA SLP License and after 4 years with an Initial Certificate, the Career Student Services Certificate is issued (a 99 year certificate) which is valid so long as the BHA SLP License is kept valid. 8. If an SLP with an Initial Certificate or the Career Student Services Certificate has misunderstood the relationship between their DESE certification and MO licensure and let their MO license lapse, what steps should the SLP take to reinstate their license and be in good standing?

If an SLP let their license lapse, they need to apply to renew their license through the Board of Healing Arts. The SLP will most likely receive some sort of reprimand for practicing without a license. The SLP should just “accept” whatever is offered by the Board to get their license reissued. They may have to catch up on CEU’s, but that should not be too burdensome for most. While this is not pleasant, once the license is reissued it will allow the individual to continue to work as an SLP. 9. Are there other implications when a therapist has let their MO License lapse, inadvertently losing their DESE certification as well?

Under Medicaid, a therapist must be a valid MO HealthNet provider in order to submit claims to MHD for services provided to Medicaid eligible students. If audited, the district must repay the money received for services provided by an ineligible SLP. Under the IDEA, it could be determined the child did not receive FAPE because the SLP was not properly credentialed. A parent could request compensatory therapy services be provided to their child by filing a child complaint with DESE or filing for due process under the IDEA.

http://pr.mo.gov/speech-rules-statutes.asp


Appendix 3: School Based Direct Services


Appendix 4: When Are Scripts Legally Required? Who Can Legally Make a Diagnosis?

When Are Scripts Legally Required?

Physical therapy services can only be provided pursuant to a prescription. No services can be

provided until a prescription from a physician is received. This is the case whether the child is

Medicaid eligible or not, and, if so, whether the intent is to bill Medicaid or not.

No doctor’s prescription or written referral is necessary to provide OT and SLP services, respectively.

Within the context of public school, both provide services in accordance with the IEP. If OT and SLP

services are part of the IEP, the district serving the student must provide or arrange for the provision

of the services by law whether they are reimbursed for the services or not. The purpose of the

doctor’s order (prescription or written referral) is to qualify the services that are already being

provided for reimbursement through Medicaid. Physicians typically review the evaluation summary

containing evaluation results and the diagnosis, as well as the IEP, prior to making such a

determination. It is theoretically possible that OT and SLP services could be included in an IEP and a

doctor determines that they are not medically necessary. In such a case, there would be no

prescription written and no reimbursement from Medicaid.

Who Can Legally Make a Diagnosis?

Physical Therapists are prohibited from medically diagnosing students in accordance with

§334.506.6, RSMo. Because PT services cannot be provided without a prescription, a medical

diagnosis will have been made by a physician. However, neither OTs nor SLPs are governed by this

statutory provision and are authorized to assess and diagnose students. OT’s, PT’s, and SLP may all

select ICD-9 (or in the future, ICD-10) codes, in support of the medical diagnoses or conditions,

required for Medicaid billing.

Section 334.050, RSMo defines occupational therapy as “the use of purposeful activity or

interventions designed to achieve functional outcomes which promote health, prevent injury or

disability and which develop, improve, sustain or restore the highest possible level of independence

of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental

illness, developmental or learning disability, physical disability or other disorder or condition. It shall

include assessment by means of skill observation or evaluation through the administration and

interpretation of standardized or non-standardized tests and measurements.” (Emphasis Added)

Similarly, speech pathologists are authorized pursuant to § 345.015, RSMo to engage in “screening,

identification, assessment, diagnosis, treatment, intervention, including but not limited to prevention,

restoration, amelioration and compensation, and follow-up services . . .”


Appendix 5: Hearing Aid Page 1 of 3 Attachment A Provider Bulletin Volume 40 Number 02


Hearing Aid Page 2 of 3

Attachment A Provider Bulletin Volume 40 Number 02


Hearing Aid Page 3 of 3

Attachment A, Provider Bulletin Volume 40 Number 02


Appendix 6: MO HealthNet Behavioral Health Services Manual

13.. 13.12.C PROCEDURE CODES The following procedure code/modifier combinations are the allowable codes for the school-based

services program and must be utilized within the provider’s scope of practice and the licensure limits.

Service Psychiatrist,PC

NS, PMHNP

Psychologist,

PLP

LCSW, LMSW LPC, PLPC

Psychiatric Diagnostic Evaluation 90791 TM 90791 AH TM 90791 AJ TM 90791 UD TM

Psychiatric Diagnostic Evaluation

with Medical Services

90792 TM N/A N/A N/A

Psychotherapy, 30 min 90832 TM 90832 AH TM 90832 AJ TM 90832 UD TM

Psychotherapy, 45 min 90834 TM 90834 AH TM 90834 AJ TM 90834 UD TM

Psych Testing - Administered by

Psychologist

96101 TM 96101 AH TM N/A N/A

Psych Testing - Administered by

Computer

96103 TM 96103 AH TM N/A N/A

Assessment of Aphasia 96105 TM 96105 AH TM N/A N/A

Developmental Testing 96111 TM 96111 AH TM N/A N/A

Neurobehavior Status Exam 96116 TM 96116 AH TM N/A N/A

Family Psychotherapy without

Patient

90846 TM 90846 AH TM 90846 AJ TM 90846 UD TM

Family Psychotherapy with Patient 90847 TM 90847AH TM 90847 AJ TM 90847 UD TM

Group Psychotherapy 90853 TM 90853 AH TM 90853 AJ TM 90853 UD TM

Psychotherapy for Crisis, 60 minutes 90839 TM 90839 AH TM 90839 AJ TM 90839 UD TM


Appendix 7: Evaluation and Re-Evaluation Billing Therapist should follow the steps below to create a billing record for evaluations using Simple Billing or Simple Management. Initial Evaluation Billing In order to create a billing record for an initial evaluation, the following rules must be met:

The Initial Evaluation must result in an IEP

The student must be Medicaid (MO HealthNet) eligible

The student must be entered on therapist’s caseload *Only time spent evaluating students may be billed. Time spent scoring evaluation, writing evaluation report, or discussing evaluation results are not billable activities. Recommended process for entering Initial Evaluations in Therapylog.com: Keep a record of Initial Evaluations. This record should contain the following information:

Name of student, Start Time, Stop Time, Notes

Keep a record of students evaluated that resulted in IEPs.

At the end of the month, therapist should add students that received initial IEPs to their caseload. Re-Evaluation Billing In order to create a billing record for a re-evaluation, the following rules must be met:

The student must have a current IEP documenting service in the area being assessed.

The student must be Medicaid (MO HealthNet) eligible.

The student must be entered on therapist’s caseload. *Only time spent evaluating students may be billed. Time spent scoring re-evaluation, writing re-evaluation report, or discussing re-evaluation results are not billable activities. To create a billing record for evaluations using Simple Billing: Therapist should:

select student from drop down box

select relevant Diagnosis code

enter start and end time of testing, according to evaluation record

select location from drop down box

select Service code (i.e., PT Evaluation/Re-evaluation, OT Evaluation/Re-evaluation, Speech/Language Evaluation/Re-evaluation)

select date of testing, according to evaluation record To create a billing record for evaluations using Simple Management: Therapist should: * create a date using the date the NOA was signed IF there is no IEP in effect for the evaluation date

create a goal indicating discipline specific evaluation: PT Evaluation, OT Evaluation, Speech/Language Evaluation

select relevant Diagnosis code

add date(s) and time(s) to calendar

select location, date, start and end time, and appointment type

select Service code (i.e., PT Evaluation/Re-evaluation, OT Evaluation/Re-evaluation, Speech/Language Evaluation/Re-evaluation)

select evaluation goal

enter assessment name(s) in activity field

document appointment on their calendar

enter any documentation from the testing session in the comments field


Appendix 8: How to use eMomed to check Page 1 of 6

Student Eligibility and Locate RAs

eMomed.com is the free electronic billing site for Medicaid claiming. From the eMomed site, districts have access to multiple features. The most common and beneficial features for administrators are verifying student eligibility and remittance advices. Those two options will be covered in the following pages.

Login using the district’s user ID and password.

After logging in to eMomed, districts will be redirected to the eProvider welcome page.


Verifying Student Eligibility Page 2 of 6

To verify eligibility, choose the Participant Eligibility option. The district may search eligibility by these three methods:

1. By the first date of service, student’s Medicaid Number and student’s date of birth 2. By the combination of the first date of service, student’s date of birth and student’s full name,

as listed with MHD, spelled correctly 3. By the combination of the first date of service, student’s date of birth and student’s social

security number Note: Be sure to use the full name of the student as listed with MHD. Do not use nicknames or shortened forms of names unless it is the official given name of the child. For example, use William instead of Bill, Julia instead of Julie, and Robert instead of Bobby, according to the name on the birth certificate. If the full name, in method two, is spelled incorrectly the eligibility response will come back with a “Reject Reason” and no information on the student. If you use the student’s name on method one or three, be sure to note whether the spelling of the student’s name is different than what you entered. That would indicate that the spelling of the name entered was different from what MHD has on file. Here is a screen shot of the Eligibility Request page. Use one of the search methods described and enter the appropriate data.


Page 3 of 6

Note: Even though it is not required, it is important to add a last day of service to your eligibility request. This will show if the student was Medicaid eligible for the entire time frame or just part of the time. Entering just the first date of service will only look for eligibility on that specific day. Here is a sample Eligibility Request run when only the first date of service is entered. If the student is eligible for Medicaid, the status will run as “Active Coverage”. If the student is not eligible for Medicaid, the status will run as “Inactive”. This screen shot shows that this student was Medicaid eligible on 08/01/2011.


Page 4 of 6 Here is a sample Eligibility Request run when the first and last service dates are entered. It indicates that the student is Medicaid eligible from 08/01/2011-09/08/2011 but is inactive from 09/09/2011-02/10/2012. The arrow is showing the time period qualifier, which indicates the length of coverage. A “7” identifies a student whose eligibility fluctuates during the month from active to non-active.

Use the “Finish” button at the bottom of the Eligibility Request page when the verifying eligibility

process is complete or if navigating back to the previous page. DO NOT use the back button in

your browser.


Accessing Remittance Advice through eMomed.com Page 5 of 6

The remittance advice, also called RA, tells the district how much was paid or denied on each claim. It contains the Student Name, Date of Service, Procedure Code, Reason and Remark Codes, quantity billed, allowed amount and paid amount.

On the eProvider welcome page select the “File Management” link.

Note: If the district has their NPI and legacy number (M50 number) linked to eMomed then there will be a drop down under the NPI field. The district’s NPI must be selected when searching for claims after 08/01/2010. Claims prior to 08/01/2010 are retrieved by selecting the legacy number. Select “Selected NPI” in Search Scope. Enter desired from and thru dates. Check the box next to “Printable RAs” and click search. Printable RAs are available for the two previous months. If you need an RA dated back more than two months you will need to request a “Printable Aged RA”. To do this you can contact MSBA Medicaid Consortium staff for assistance.


Page 6 of 6

Click the icon next to the RA date to download and print the RA. If you need to go back to the previous screen click “Finish”. DO NOT click the back button in your browser.


Appendix 9: Step-by-Step Guidance for Accessing Reports

DIRECT SERVICES ADMINISTRATIVE MANAGEMENT

Step-by-Step Guidance for Accessing Reports to Monitor and Manage Direct Services

1. Go to www.therapylog.com

2. Enter your email address and password and click “Login”. (If you don’t know your password, please call

an MSBA representative for assistance.)

3. Click on the “Therapist Tools” tab and then click on “My Reports.”

4. OR, Click on “Reports” in the top right hand corner of the Home Page.

5. Click on the name of the report and complete filters, as appropriate.

6. The generated report will be sent to your email address and posted to the Home Page under “Generated

Reports.” NOTE: The link to the generated report in your email will only work for 24 hours. However, the

generated report on the Home Page will remain until deleted or until it drops from view due to the number of

generated reports in the listing.

Commonly Used Reports to Monitor Student/Therapist Specific Data, Unbillables and Goal Progress

Looking for information on... Report Name

Student Medicaid Eligibility Student Medicaid Data Snapshot

Listing of Students' Names on a Script Batch Report of Script Request

Total Transactions Recorded by Individual

Therapist

Service Summary For Therapists

Unbillable Transactions by Student Students: Unbillable Transactions

Unbillable Transactions by Therapist Therapists: Unbillable Transactions

Monthly Transactions Report by Therapist Month-End Billing Documentation Record

Monthly Individual Student's Therapy Sessions

by Therapist

Comprehensive Record of Therapy

How to Access Direct Services Record of Payments in Therapylog.com

1. Go to www.therapylog.com

2. Enter your email address and password and click “Login”. (If you don’t know your password please call

an MSBA representative for assistance.)

3. Click on the “Admin tools” tab and then click on “Direct Services Dashboard.”

4. Click on “Payment.”

5. A listing of payments will be posted.

6. Click “Generate Summary,” to the right of a payment, to view all of the transactions that comprise that

payment.

7. The generated report will be sent to your email address and posted to the Home Page under “Generated

Reports.” NOTE: The link to the generated report in your email will only work for 24 hours. However, the

generated report on the Home Page will remain until deleted or until it drops from view due to the number of

generated reports in the listing.


Appendix 10: Therapylog.com Report Descriptions Page 1 of 5

ADMINISTRATOR’S REPORTS Month-End Billing Documentation Record (Audit Record: Print Monthly for each student.) Once therapists have completed their documentation, this record should be printed each month for each student on a therapist’s caseload that was Medicaid eligible for all or any part of the month. According to MO HealthNet Division, each session must be initialed and each page signed by the rendering provider. This report contains fields for all of the MO HealthNet requirements for adequate documentation that must be maintained in the student’s medical record for 5 years after the date of service. This is the report therapists use to meet the requirement that each therapy session must be signed by the providing therapist. Note for Simple Billing: Therapists utilizing Simple Billing may print, sign, and attach written therapy notes to this monthly report to meet adequate documentation requirements. New technology, such as the iPad, will allow therapists to sign directly on the iPad surface, no longer requiring this report to be printed monthly. Signatures on the iPad at the time of therapy documentation will be maintained on the electronic report for audit purposes. DIRECTIONS: Print the document. Therapists must initial each session and sign each page of the document to be filed in the student’s medical record. Comprehensive Record of Therapy This record contains all information entered by a therapist into Therapylog regarding individual student’s therapy sessions in an easy-to-read, well organized manner. The report is designed to be a complete back-up record to the Month-End Billing Documentation Record, and as such, can be maintained electronically. Administrators and therapists are encouraged to use this report for any purpose and in any manner deemed beneficial in the IEP process or in case of an audit review. Fixable Unbillable Transactions This report is available for therapists and administrators both. It is used for determining Fixable Unbillable Transactions that were identified in either the “My Medicaid Transactions” report (Therapist Only Report) or the “Therapist Billable Transaction Count” report (Admin Only Report). It will give the therapist and admin a list of all the transactions by date and student name (for a given time period) that are unbillable for the following reasons: No IEP Date, Expired IEP Date, No ICD Diagnosis Code, Evaluation Time Exceeds Billable Limits, Wrong Service Code and No Current one-time parental consent.

Provider Service Details You will see a list of services provided for a specified date range for either an individual student or all students on a provider’s caseload. This report can be filtered by therapist or student. This report is useful for drilling down into specific service details.

Service Summary For Therapists (Recommendation: Print Monthly.)

This report can be used by administrators to monitor the use of Therapylog by the district’s therapists for Medicaid eligible (ME) and non Medicaid eligible (non ME) students on their caseload. Provider type and therapist's name will be followed by the number of ME and non ME students (if selected), number of transactions, total minutes of service, and total units of service for ME and Non ME students (if selected) for a given date range. Administrators may also choose to include the number of transactions for non-billable services, such as IEP meeting, RED, etc. In addition, the administrators will be able to see how many of the ME students do not have one-time parental consents and how

https://www.therapylog.com/reporting/month_end_report_selection

https://www.therapylog.com/reporting/detailed_month_end_report

https://therapylog.com/reporting/provider_service_details_selection

https://therapylog.com/reporting/provider_service_summary_selection


Page 2 of 5

many of the transactions are not documented by the therapists. This report could also be useful if you needed to see at a glance the number of total units recorded by your therapists. Providers Required to have NPI Numbers This report will provide a listing by name and provider type of providers with NPI numbers and those without NPI numbers for those providers required to have NPI numbers to bill Medicaid. RNs, LPNs (Private Duty Nursing) and Personal Care Aides are not required to have NPI numbers to bill Medicaid for Private Duty Nursing or Personal Care direct services. RNs, LPNs and Personal Care Aides will not be included in this report.

Trouble Shooting Unbillable Reports (Reference guide for two unbillable reports below.)

This general guide provides descriptions of problems that a district may be experiencing with therapy transactions that are preventing them from being submitted to MHD and gives specific recommendations to resolve the problem(s). This information, when used in concert with the Students: Unbillable Transactions report and the Therapists: Unbillable Transactions report, allows the district to correct the problem(s) thus enabling the claims to be filed in the next billing cycle. Students: Unbillable Transactions (Recommendation: Print Monthly.)

This report will provide a summary of the student specific reasons why transactions are currently unbillable, the number of unbillable transactions and the potential revenue for those unbillable transactions by each provider type that serves the student, such as OT, PT, and/or ST. Therapists: Unbillable Transactions (Recommendation: Print Monthly.)

This report will provide a summary of the therapist specific reasons why transactions are currently unbillable, the number of unbillable transactions and the potential revenue for those unbillable transactions. Student Medicaid Data Snapshot You will have access to a table that shows the following student specific information: student ID, name, and birthdate; Medicaid eligibility status; one-time parental consent status; IEP and Re-evaluation dates; and prescription status, including prescription expiration date. All Appointments By Therapist This report shows a table based on a specified date range for either all therapists or a specified individual therapist. The following information is displayed: therapist’s name, transaction dates, the start and stop times of each session, the status of the transaction, and the location of the service. This report shows at a glance time commitment and work load of therapist(s) in relation to the Medicaid eligible students on a therapist’s caseload.

Therapist Billing Summary This table shows the therapist's name, student name, the number of services recorded for this therapist/student combination and the amount of money generated from these transactions. This report makes it simple to see how much each therapist is generating at a glance. Therapist Billable Transaction Count A table can be generated for an individual therapist, therapists by group or all therapists for a specified time frame. The following information is included: the therapist(s) name(s), total transactions, total unbillable transactions requiring corrections by therapists, total billable

https://therapylog.com/reporting/therapist_roster

https://therapylog.com/reporting/student_eligibility



https://therapylog.com/reporting/therapist_billing_summary_selection

https://therapylog.com/reporting/billable_service_count


Page 3 of 5 transactions, total number of unbillable transactions for any reason, and total transactions that are eligible for reimbursement from Medicaid. Medicaid Eligible Students Transaction Count This report represents the number of transactions for each Medicaid eligible student for a specified time range. Medicaid Eligible Students With Direct Services In real time this report displays a comprehensive visual of each direct service a child receives along with the direct service provider’s name according to caseload assignment. It also indicates when transportation and personal care aide are services provided to the student. This report will require modification to the excel file (adjustment to scale) in order for the report to print on one page. Provider Service Minutes This report displays for all students on a specified therapist’s caseload. It shows how many minutes of therapy each student on the caseload has received compared to each student’s IEP minutes over a given time period. Report of Script Requests This report will provide a listing of students in alphabetical order with the script batch ID, generation date for a single date or date range, script type (ST/OT/PT) and status of script (open or closed). Districts using MSBA Assisted Script Generation Service (Send Prescriptions to MSBA) would find this report most helpful. Administrators may access this report after generating a batch or batches of scripts for a record of those students for which prescriptions have been requested through the MSBA Assisted Script Generation Service. Those administrators generating printable prescription batches may also access this report; however the Script Check Off document that accompanies the printable prescriptions, may be sufficient. NOTE: Open means the script has not been completed. Closed means the script has been completed. Provider Compliance Report This report shows, by month, an entire school year of documented minutes, units, or services entered by all providers. The report can be customized to compare numbers from the prior school year and filtered to see either all students or just those that are Medicaid eligible Lesson Plan by Date Range This report represents therapist specific lesson plans for a designated period of time.

Behavioral Health Summary Report

Support School Personnel Minutes Report Support School Personnel Summary Report

https://therapylog.com/reporting/eligible_student_transaction_count

https://www.therapylog.com/reporting/prescription_batches

https://www.therapylog.com/reporting/provider_compliance_report

https://therapylog.com/reporting/bh_summary_report

https://therapylog.com/reporting/ssp_minutes_report_selection

https://therapylog.com/reporting/ssp_summary_report


Page 4 of 5 THERAPIST’S REPORTS Month-End Billing Documentation Record (Audit Record: Print Monthly for each student.) Once therapists have completed their documentation, this record should be printed each month for each student on a therapist’s caseload that was Medicaid eligible for all or any part of the month. According to MO HealthNet Division, each session must be initialed and each page signed by the rendering provider. This report contains fields for all of the MO HealthNet requirements for adequate documentation that must be maintained in the student’s medical record for 5 years after the date of service. This is the report therapists use to meet the requirement that each therapy session must be signed by the providing therapist. Note for Simple Billing: Therapists utilizing Simple Billing may print, sign, and attach written therapy notes to this monthly report to meet adequate documentation requirements. New technology, such as the iPad, will allow therapists to sign directly on the iPad surface, no longer requiring this report to be printed monthly. Signatures on the iPad at the time of therapy documentation will be maintained on the electronic report for audit purposes. DIRECTIONS: Print the document. Therapists must initial each session and sign each page of the document to be filed in the student’s medical record.

Comprehensive Record of Therapy This record contains all information entered by a therapist into Therapylog regarding individual student’s therapy sessions in an easy-to-read, well organized manner. The report is designed to be a complete back-up record to the Month-End Billing Documentation Record, and as such, can be maintained electronically. Therapists are encouraged to use this report for any purpose and in any manner deemed beneficial in the IEP process or in case of an audit review. Fixable Unbillable Transactions This report is available for therapists and administrators both. It is used for determining Fixable Unbillable Transactions that were identified in either the “My Medicaid Transactions” report (Therapist Only Report) or the “Therapist Billable Transaction Count” report (Admin Only Report). It will give the therapist and admin a list of all the transactions by date and student name (for a given time period) that are unbillable for the following reasons: No IEP Date, Expired IEP Date, No ICD Diagnosis Code, Evaluation Time Exceeds Billable Limits, Wrong Service Code and No Current one-time parental consent.

Student Progress Report (See Comprehensive Record of Therapy) This report is generated for either a specified student or for all students on a caseload. The report displays for a therapist-selected time frame the following information for each therapy session by service date(s): student name, goal(s) and benchmarks as applicable, activity(s), progress, percentage and comments, according to what had been entered into Therapylog.com. Student Progress Summary This report compiles quantitative progress for each goal and benchmark, as applicable, for all of the students on a specified therapist’s caseload for a specified date range. It will display each student and his/her percentage for each goal and benchmark over that time period.

https://www.therapylog.com/reporting/month_end_report_selection

https://www.therapylog.com/reporting/detailed_month_end_report

https://www.therapylog.com/reporting/therapist_unbillable_transactions

https://www.therapylog.com/reporting/student_progress_report_selection

https://www.therapylog.com/reporting/student_progress_report_summary


Page 5 of 5 Single Event Report This report, within a specified date range, displays each student’s appointment(s), with all the relevant appointment details in a single report. Student Attendance This report identifies, by transaction date(s), which student(s) were absent and which were present within a specified date range.

Events by Student This report will display evaluation(s) and therapy(s) by date of service, type of service, location and progress for each student to whom the evaluation/therapy was provided during a specified time frame. Provider Service Minutes This report displays for all students on a specified therapist’s caseload. It shows how many minutes of therapy each student on the caseload has received compared to each student’s IEP minutes over a given time period. Customizable Report This report allows the therapists to define a time frame and specify several different parameters to drill down to detailed information. If used following the entry of your billing records you can quickly identify billing errors when compared to your therapy record. This allows for timely correction of billing errors prior to the processing of a claim and claim payment. Highly recommended. My Medicaid Transactions For a therapist’s selected time frame all Medicaid transactions with billable service codes for Medicaid eligible students, who were present in their therapy session(s) will be included in this report. Active Goals for Caseload Students This report displays a listing of all students on a specified therapist’s caseload, along with each student’s active goals and benchmarks, if applicable. Lesson Plan by Date Range This report represents therapist specific lesson plans for a designated period of time. Support School Personnel Summary Report

https://www.therapylog.com/reporting/single_transaction_report_selection

https://www.therapylog.com/reporting/student_attendance

https://www.therapylog.com/reporting/transaction_by_student_selection

https://www.therapylog.com/reporting/therapist_customizable_report

https://www.therapylog.com/reporting/exec_caseload_students_active_goals

https://therapylog.com/reporting/ssp_summary_report


Appendix 11: Provider Update Request Form


Notes:


Contact the MSBA Medicaid Consortium

Collin Swearingen

email: [email protected] phone: 573-673-2013

Lisa Helm


Ashley Branstetter


www.mosba.org

800-221-MSBA (6722)

mailto:[email protected]

mailto:[email protected]

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