Physical Therapists and Occupational Therapists. An Overview

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1 Physical Therapists and Occupational Therapists An Overview

2 Federal regulations permit and encourage school systems to recover costs from public health insurance (Medicaid) for services identified in a child s IEP. The Medicare Catastrophic Coverage Act (Public Law PL July 1, 1988)

3 PGCPS Medicaid recoveries have increased by 34% for SY $9 million recovered annually and funneled back to Special Education

4 The school district bills Medicaid for faceto-face health-related IEP assessments and services: Speech/Language Therapy Occupational & Physical Therapy Nursing Psych Services Nutrition Services Audiological Services

5 The school district also bills Medicaid for other IEP services: IEP Coordination Services Specialized Transportation Autism Waiver

6 Active IEP Health-related discipline documented on IEP as a related service Billed services relate directly to IEP Medicaid eligible student under 21 Qualified practitioner (proper licensure/ certification, etc.)

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9 For direct (face-to-face) health related services - Licensed by the State of Maryland as an Occupational Therapist or a Physical Therapist PTAs under direct supervision of a licensed PT COTAs under supervision of a licensed OT For IEP service coordination - OT/PT licensed by the State of Maryland

10 Billing forms sent to schools by 10 th of each month SLP/OT/PT completes billing forms and attaches Service Logs Billing forms due back 5 th of following month

11 In general, the required documentation for Medicaid billing is: Monthly Service Record form MD Online Related Services Log Copy of Evaluation Report when billing under the following codes: Code 10 PT Evaluation* Code 11 PT Re-Evaluation Code 20 OT Evaluation* Code 21 OT Re-Evaluation * OT/PT evaluations are billable regardless of whether the students qualifies for services.

12 Date of services (billable dates only) Type of service in Encounter Code 10 - PT Evaluation 11 - PT Re-Evaluation 12 - PT Therapy Service 20 - OT Evaluation 21 - OT Re-Evaluation 22 - OT Therapy Individual 23 - OT Therapy Group

13 Session Number See attached log in Comments field Sign & Print Name (original signatures only) Attach supporting documentation

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15 Service Log Documentation: Include start and stop times Write a goal for each session Write goal in measurable terms (e.g. 50% accuracy or 1 out of 2 times) Write detailed description of your service/ therapy; include a measurable outcome (e.g. 3 out of 4 times) Sign the log and initial each session

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18 Update Related Service Log Denote M/U in Type of Service field Include in the Description of Services Provided field The date of the missed session (example: 7/11/2013) Description of services provided A Make-Up session cannot be billed on the same day of another session

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21 Non Billable Services - Do not list any other type of session ( i.e., IEP Meetings & Consultations) on the Monthly Service Record. Absentee Dates Do not list any date(s) a student was absent. Verify all dates billed against the student s attendance record. Good Housekeeping Do submit forms by the 5 th of the following month. Do submit a MD Online Service Log for each billing month. Please do not send one log for multiple months of billing. DO staple the MD On-line Related Service Logs to the Monthly Service Record.

22 All Medicaid Monthly Service Record Forms should be returned to the Medicaid Recovery Office even when services were not provided during the month. It is very important that we maintain an accurate accounting of all forms. When forms are returned to the Medicaid Recovery Office the schools/providers are given credit for the submission of the forms regardless of whether services were provided during the billing month.

23 1 Health Related Services Manual Provides guidance related to understanding federal and state MA regulations billing procedures and process. 2 Medicaid Recovery Office Website Provides access to the Medicaid Health Related Training Manual, Monthly Service Record forms, Parent Consent forms, and Change of Status forms, { 3 Medicaid Staff We are available to personally assist you.

24 Please visit our website for the most current information and forms.

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