Third Party Billing. Introduction

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2 Third Party Billing Introduction Julie Stoneking Third Party Billing Coordinator Brookside Education Center Room 240 Part time Program Started 2000/2001

3 What is Third Party Billing? Federal reimbursement to schools for medically necessary services to student with public & private health insurance. Billable Services are: Speech, Occupational Therapy, Physical Therapy, Mental Health, Nursing, Personal Care, Special Transportation, Assistive Technology, Oral Language Interpreter.

4 What is needed before we bill? Parental consent IEP/IIIP/IFSP Daily Documentation Supervision DHS PCA certificate of training-once

5 Who will be supervising me? Carol Bosma RN, LSN ECSE, All Elementary, ALC Lisa Dugger RN, LSN Southwest, High School Dr. Mary Larscheid, MSW, PHD,LICSW All Behavior only students

6 Para vs. PCA A Para Educators roll is to be a PCA s Personal Care Attendants when billing Medical Assistance

7 PCA Responsibilities Communicate effectively with the child (speak the child s language, sign, etc); Communicate with the qualified professional (report changes in child s condition to; contact with questions or concerns); Provide services according to care plan; Respond appropriately to the child s needs; Maintain daily documentation.

8 Qualified PCA services are: Activities of daily living (ADL's): The following services and supports furnished to an individual, as needed, to assist in accomplishing activities of daily living including health and hygiene activities integral to the activity (e.g., cleaning up spills, laundering soiled clothing, and cleaning up toileting accidents):

9 PCA Services/Toileting, Grooming Toileting: assistance with helping a child with bowel or bladder elimination and care including diapering, transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and adjusting clothing. Grooming: assistance with personal hygiene including basic hair care, oral care, shaving, applying cosmetics and deodorant, and the care of eyeglasses and hearing aids (hearing aid checks are not covered). Nail care is included except for children who are diabetic or have poor circulation.

10 PCA Services/Dressing, Bathing Dressing: assistance with choosing, applying or changing clothing for the child, applying special appliances (orthotics and prosthetics) or clothing (TED hose). Bathing: assistance with basic personal hygiene and skin care for bathing or showering including transfers and positioning, using soap, rinsing, drying, skin inspections, and applying lotion.

11 PCA Services/Transfers, Mobility Transferring: assistance with moving a child from one seating/reclining area to another (including, standing by to assist if needed, pivoting the person, two person assists and using a Hoyer lift). Mobility: assistance with ambulation including using a wheelchair and assisting a person with ambulation. Mobility does not include providing transportation.

12 PCA Services/Positioning Positioning: assistance with positioning or turning a child for necessary care and comfort including relieving pressure areas, positioning using pillows, wedges or bolsters and repositioning him/her in a wheelchair, bed, chair or sofa.

13 PCA Services/Health procedures or task Health related procedures and tasks, including those listed below, that do not require the skill of a nurse, are supervised by an RN, PHN, or LSN and can be assigned, under state law, by a health care professional to be performed by a PCA. PCAs cannot complete sterile procedures or give injections. The PCA may be trained to:

14 PCA Services/Health procedures or task Provide ROM-range of motion and passive exercise to maintain a level of strength and muscle functioning. Assist with self-administered medication. A PCA may remind the child to take his/her medication, hand the child his/her medication and/or assure the child has taken or administered the medication to him/herself. Selfadministered medication means medication taken orally, by injection or insertion or applied topically without the need for assistance.

15 PCA Services/Health procedures or task Observe, monitor and intervene for seizure disorders when the child has had a seizure within the last three months. Tracheostomy suctioning and ventilator care Clean not sterile procedures Supervised by a nurse Trained by a nurse, respiratory therapist or physician

16 PCA Services/Behaviors Intervention and redirection for behavior that is medically necessary and related to the child s disability. Intervention and redirection for behaviors that fit into one or more of the three categories below:

17 PCA Services/Behaviors Increased vulnerability due to cognitive deficits or socially inappropriate behavior (e.g. child with a traumatic brain injury, a syndrome that causes significant mental disability);

18 PCA Services continued/behaviors Resisting care and verbal aggression that cause care to take longer than normally expected; Physical aggression towards self or others or destruction of property:

19 PCA Services continued/behaviors Self-injurious behavior -causes injury to one s own body; examples: hitting, biting, head-banging, burning, poking or stabbing, ingesting foreign substances or objects, pulling out hair, and suicide threats. Physical injury to others - causes physical injury or has the potential for causing physical injury to other people; examples: hitting, biting, pinching, scratching, kicking, stabbing, and pulling out hair. Destruction of property -causes damage or has the potential to cause damage to things; examples: breaking desks or chairs, tearing clothes, setting fires, and using tools or objects to damage property.

20 PCA Forms Personal Care Services form or Plan of care Daily PCA Log LPN daily log (yellow) Transportation Log (orange)

21 Who completes the Forms? Every Para/PCA working eligible student receiving PCA services. Teachers are not eligible providers so they will never sign PCA log s LPN vs. Para/PCA

22 Assistance needed examples: Use as few words as possible. However you must include step by step how you help with the PCA task, How/if the student self helps(is it a verbal or physical assist or hand over hand), any triggers to watch for, how you intervene.

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24 PCA Daily log. To be completed DAILY! To be signed & mailed to Brookside Monthly Keep a photo copy for your records

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26 Behavior Redirection #2 Toileting ROM js js js js js js js 1 js 1 Julie Stoneking/PCA Julie Stoneking/pca

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28 What staff needs to know: PCA Forms available via or supervisor Daily PCA logs. Make your own copies monthly (use back to back copies) Save a copy of Personal Care Services form for yourself and place in your para sub file Have daily logs & a copy of Personal Care Services form available when supervision visits are made. Supervisors need to look at them. Expect Supervision within the first 7 days, every 90 days for the first year and every 120 days after the first year. Interschool mail daily documentation logs last day of each month. PCA Log s begin First Day with Student

29 Special Transportation Log

30 Department of Human Services NO-NO S in documentation!!! Because PCA logs are medical documents: No Pencil No Red ink No White Out No Ditto Marks No arrows No filling out forms weekly or monthly No Scribbling out errors JS

31 What to expect. Supervisors will meet with PCA for 7 day supervision. The special ed. teachers will have: PCA log s Plan of Care Transportation logs Nursing logs *Start PCA log s first day with students.

32 How do we communicate? , so check your often Call me with ANY questions Julie Stoneking Brookside room )w )c