TO: SW/WC Service Cooperative IEP HEALTH RELATED PROVIDERS 3 rd Party Billing Coordinators FROM: Martha Ritter, Third Party Billing Dellynne Monson, Third Party Billing DATE: June 11, 2015 RE: IEP Billing Changes and Clarifications Attached is the MDHS/MDE IEP Billing Changes and Clarification memo that came out April 17, 2015. They have deemed it necessary for IEP health service providers to identify if their services are either s or therapy. Simplified it means the following to you as an IEP health service MA biller: After August 1 (when SpEd forms has completed their quarterly update), on your activity log you will be given the choice in the Type of Service Provided dropdown menu for either services or therapy services. When you choose the dropdown pertaining to the type of service you provided, it will automatically change the necessary coding needed for MA billing. There will be three dropdown choices for Type of Service Provided will look like this, e.g., Physical therapy PT eval and therapy services use for services provided prior to 07-01-15 PT s only - use for evals provided after 07-01-15 PT TM direct services only use for therapy services provided after 07-01-15 OR OR Tips: SpEd forms has been working to implement these changes that will affect billing starting July 1, 2015. HOWEVER, because our SpEd forms server is on a quarterly update schedule, billing input for services starting July 1, 2015 will not be able to be completed until after August 1, 2015 (the quarter update timeline.) Do not log for July and August Claims until after the August SpEd forms update. It is imperative to use the correct Log Date on the activity log in order to pull the correct billing information that is sent to MDHS for billing. Always use the last day of the month in which the service is being provided. If both an and face-to-face therapy services are completed in the same month; a separate activity log will have to be done for each type of service. You cannot bill for both and face-to-face therapy occurring in the same month on the same activity log. DO NOT USE the DUPLICATE log feature when creating new logs until after you have created a new activity log for the 2015-16SY. Otherwise incorrect billing information will be pulled from the 14-15SY that does not apply for 15-16 billing. 3 rd Party Billing Coordinators: I am sending this memo to all SW/WC service cooperative IEP health related staff; however, you need to please share this information with your IEP health related district staff where applicable including contracted service providers.
Thank you for your cooperation with this new process. Martha Martha M. Ritter Regional 3 rd Party Billing Asst. SW/WC Service Cooperative Montevideo Office 306 N. First Street Montevideo MN 56265 Phone: 320.269.9243 Fax: 320.269.7132 martha.ritter@swsc.org
IEP Billing Changes and Clarifications April 17, 2015 MHCP Provider Update IEP-15-02 The Department of Human Services (DHS) and Minnesota Department of Education (MDE) staff recently noted discrepancies in how school districts have been billing IEP s (sometimes called assessments) and re-s. Some schools are billing only for the health-related s or re-s that are identified in the child s IEP, while other schools are billing for all health-related s performed using a rule out method, as long as one or more health-related service is identified in the child s IEP. Currently schools submit the same HCPCS code (T1018) and modifiers when submitting claims for both IEP health-related services and s (except for mental health). We have also found that the modifier 76 is sometimes used incorrectly for a service that is not special transportation. What is changing? DHS is making system changes to add an additional modifier to IEP health-related service claims so that we can determine when a claim is for an IEP or when it is for an IEP service. After the system changes are made and schools are using the modifiers, we will be able to identify more definitive counts for claims and clarify the billing criteria for IEP s and re-s. What do I need to do? Continue to bill for s exactly as you have been until July 1, 2015. Effective for dates of service on and after July 1, 2015, schools must use the new procedure codes and modifiers when submitting claims. How do I bill for services? Starting July 1, 2015, be sure to use the correct procedure code with the corresponding modifier or modifiers as shown in the tables below. IEP and re- Use the procedure codes and modifiers from the following table to bill for s performed by an IEP health-related service professional, working within their scope of practice.
Procedure code and modifier table for s Evaluation (Assessment) Procedure Code Modifier Unit Limits Physical Therapy T1018 U1 only 1 per completed Occupational Therapy T1018 U2 only 1 per completed Speech/Audiology T1018 U3 only 1 per completed Mental Health T1018 U4 only 1 per completed Nursing T1018 U5 only 1 per completed Note: Use the date that the, and all billable hours for the or assessment, is completed as the date of service on claims. No other modifiers are allowed on claims for s IEP health-related services Use the procedure code and modifier from the following table to bill for services approved by the IEP team, and performed or delegated by an IEP health-related services professional, working within their scope of practice. Procedure code and modifier table for physical therapy, occupational therapy, speech and audiology, mental health, nursing and PCA services Service Procedure Code Modifier Units Limits Physical Therapy T1018 U1 and TM* 1 per day Occupational Therapy T1018 U2 and TM* 1 per day Speech and Audiology T1018 U3 and TM* 1 per day Mental Health T1018 U4 and HE* 1 per day Nursing T1018 U5 and TM* 1 per day PCA T1018 U6 and TM* 1 per day * Note: Modifier 77 When two districts provide the same service on the same day to the same child, both districts must use modifier 77, in addition to the modifier assigned to that service, to avoid denied claims. Use the procedure code and modifier from the following table to bill for IEP health-related s and services approved by the IEP team and ordered by an IEP health-related service professional working within their scope of practice. Procedure code and modifier table for assistive technology, special transportation and interpreter services
Service Assistive Technology Procedure Code T1018 Modifier U7, TM add additional modifier Units Limits 1 per NU for purchase of new RR for rented RB for repair of RA for replacement of Special Transportation T1018 U8 and TM first trip of the day 1 per trip U8, TM and 76 for additional trips on the same day Interpreter Services T1013 No modifier required 1 per day What does MHCP pay for or re-? MHCP pays the federal share of IEP s or re-s that result in ongoing IEP health-related services that are identified in the IEP plan for children only if the child has a disability, and because of the disability, the child needs special education and health-related services to attend school and receive a Free Appropriate Public Education (FAPE). MHCP does not cover child-find costs or the educational portions of an or res.