Billing & Payment Quarterly Webinar Q2-2020Revisions to Billing GuidelinesEffective November 2019Presenter: Kaliope Schmidt, Interim Manager Contract Administration and Provider Monitoring

Housekeeping• This presentation is for HCS and TxHmL providers.

• Questions regarding other programs will not be answered during this presentation.

• Home health, PASSR, Nursing and Hospice providers: This presentation does not apply to your programs.

• The webinar may end sooner than the listed time-depending on flow and questions submitted.

1/30/2020 B&P Webinar Q2-2020 2

B&P Presentation Sections• Format changes to BGs

• Section revisions to BGs: • Additional language• Definitions• Requirements

• Q&A session: Questions submitted and questioned asked during this webinar

1/30/2020 B&P Webinar Q2-2020 3

Format Changes to Billing GuidelinesUpdates and Revisions

1/30/2020 B&P Webinar Q2-2020 4

Format Changes• Mirrors TAC rules.

• Easier for providers to follow all requirements.

• Better understanding of citations.

• Changed DADS to HHSC.

1/30/2020 B&P Webinar Q2-2020 5

Format Changes - ExampleCitation for missing description of activities and signature on REH service delivery log:• Previous Citation(s): 3820(1.1)

• Current Citation(s): 3820(a)(1)(D)(i) and 3820(a)(1)(F)

• Specific citation corelates with exact section in BGs.

1/30/2020 B&P Webinar Q2-2020 6

Format Changes• Program providers that were not present for the

review will be able to pin point citations.

• No longer have one citation that covers a range of requirements.

• HCS, TxHmL and CFC BGs: alpha-numerical.

1/30/2020 B&P Webinar Q2-2020 7

Section Revisions toBilling Guidelines

1/30/2020 B&P Webinar Q2-2020 8

Section 2000 - DefinitionsEdits made to definitions of:• Clean claim: Assists providers in understanding

citations of “conflicting information”.• Residence: An established place that is a single

structure.

Deleted:• “Prior Approval” since HHSC does not give prior

approval for billing of service claims.

1/30/2020 B&P Webinar Q2-2020 9

3800 - Written Documentation Requirements• Section 3820 added the requirement that the

service delivery log must be completed by the service provider that is providing the service.

• This eliminates supervisory or administrative staff, that have no interaction with the individual, from completing the log.

1/30/2020 B&P Webinar Q2-2020 10

4380 - Written Documentation Requirements for Dayhab• Adds a requirement for the service provider

completing the DH log to have provided all or at least a portion of the service component.

• Applies to service providers that actively work with the individual throughout the day.

• Does not apply is service provider is simply logging in/out times.

1/30/2020 B&P Webinar Q2-2020 11

Residential Assistance• Sections 4550, 4560, and 4570 had a list of

required information that needs to be listed on the service delivery log when an individual was “out on pass” or “away”.

• Current BGs do not have requirement of location of visit be included on the log when visiting family or friend(s).

1/30/2020 B&P Webinar Q2-2020 12

4560 Residential Support Subcomponent(b) Requirement Regarding Extended Shifts and Prohibition of a Shift more than 24 Consecutive Hours (1) Off Duty RequirementIf a service provider works an extended shift, the service provider must be off duty for at least eight hours before working another shift of any length.

(2) No Shifts of More than 24 HoursA program provider may not have a service provider work more than 24 consecutive hours.

1/30/2020 B&P Webinar Q2-2020 13

4560 Residential Support Subcomponent• Extended shift: During a 24-hour period, a

combined period of time of more than 16 hours.

• Why is this important to show on documentation?• Why can’t a service provide of RSS work an entire

day (weekends or days with no DH)?

1/30/2020 B&P Webinar Q2-2020 14

4560 Residential Support Subcomponent(a) Requirements of Setting

(2) Availability and Presence of Service Provider A service provider must be:

(A) available to provide residential support to an individual, as needed; (B) present and awake in the residence when the individual is present in the residence; and (C) available to provide services for at least two shifts in one calendar day (one shift during the day and one shift at night during sleeping hours).

1/30/2020 B&P Webinar Q2-2020 15

4600- Respite• Adds an individual can receive respite in a camp

setting if the camp is accredited by the American Camp Association per TAC 9.174 (a)(43)(D).

4630 Respite in Residence or During Overnight Stay in Non-residence

(b) Non-residence (2) An individual may receive respite in a camp setting if the camp is accredited by the American Camp Association.

1/30/2020 B&P Webinar Q2-2020 16

6160 Adaptive Aids• Adds requirements for how program providers

obtain proof of non-coverage by Medicaid and Medicare through the individual’s managed care organization (MCO).

• Deletes the requirement that program providers use one annual vendor.

1/30/2020 B&P Webinar Q2-2020 17

Appendix IB&P Review Protocol• Revises the frequency of routine reviews from

every two years to every four years.

• Adds an additional method HHSC can recoup funds from a program provider if funds cannot be recouped through the automated billing system (CARE).

1/30/2020 B&P Webinar Q2-2020 18

Appendix VIIBillable AA• Revises numbers to indicate Medicaid coverage for

individuals of all ages and individuals under 21.• Updates the list to indicate items currently

covered by Medicaid.• Adds licensed professionals that can recommend

the AA for some items.• Adds clarification of Medicaid coverage for some

items.

1/30/2020 B&P Webinar Q2-2020 19

Questions1. We serve an individual that lives in their own home

alone and receives RSS. a) Are you saying that staff have to be present 24

hours a day?

2. Every single DME (that is contracted with the individual’s MCO) stated that they cannot obtain a denial as the padding for hospital bed is not billable through Medicaid.

a) How can I go about obtaining the padding through AA if I’m not able to get the necessary denial.

1/30/2020 B&P Webinar Q2-2020 20

Questions3. Numerous individuals receive HCS services and are being asked to purchase VIA trans tickets (public transportation door to door).

a) Can providers ask individuals to do this?

4. Do contractors for the MHM need to be licensed?

1/30/2020 B&P Webinar Q2-2020 21

Questions5. Are there specific hours during the day that the Dayhab Service is allowed to be provided and billed?

a) Or can the service be provided anytime as long as it entails the billable activities listed under the service component?

6. Could you please provide me with the maximum for minor home modifications and is it a lifetime limit?

1/30/2020 B&P Webinar Q2-2020 22

Questions???• We will take a few moments to organize the

questions received during this webinar.

• Please submit your questions through the webinar.

• Questions that do not meet the scope of Billing and Payment will not be answered.

1/30/2020 B&P Webinar Q2-2020 23

B&P Contact Info• Unit Mailbox:

hcs.txhml.bpr@hhsc.state.tx.us

• Unit Hotline:512-438-5359

1/30/2020 B&P Webinar Q2-2020 24

Thank youBilling and PaymentContract Administration and Provider Monitoring

1/30/2020 B&P Webinar Q2-2020 25