Family Preservation ServicesBilling and Payment

…or…

“Everything You Ever Wanted to Know About Billing…But Were Afraid to Ask!”

A training module for FPS therapists created byCheri Johnson, MSW

Central Washington University

for Children’s AdministrationOlympia, Washington

Introduction

This training will focus exclusively on all FPS billing and payment procedures.

• Prior to reviewing this material, it is important that the FPS therapist has already read through the Client Service Contract and completed the “Deliverables” training.

Before beginning this training….

Please have the following items handy:Your copy of the FPS Client Service Contract

Handouts, plus a blank copy of the FPS Monthly Status Report

Highlighter

Note-taking implements (pen and paper, sticky notes)

Completing theMonthly Status Report

The Monthly Status Report…

• Is a CA-designated document which may not be altered or replaced with a substitution.

• Is the sole means by which a contractor may submit FPS billing and reimbursement requests to Children’s Administration.

The Monthly Status Report…

• Consists of two distinct parts, the narrative portion and the Financial Reconciliation Page.

• Both parts should be completed at the same time and submitted to the fiduciary specialist as one document (along with any required receipts).

The Monthly Status Report…

• Must be received by the fiduciary specialist for your provider and region by the 10th working day of each month…

• …However, the earlier your reports are submitted, the sooner you will receive payment from CA!

Let’s take a look at the Monthly Status Report, and walk through it item by item.

• Please get out your copy of the MSR, along with a pen or pencil, and a highlighter, if desired.

• We’ll also be referring to the FPS Client Service Contract, so you might want to keep it handy.

Narrative Section

The narrative portion of the Monthly Status Report is subdivided into three specific sections: a heading, a table, and the narrative itself.

The Heading

Fill in all information accurately and completely.

• The phone number requested is YOURS, not the social worker’s—this is in case the fiduciary specialist has a question regarding your report and needs to contact you.

The current service time period refers to those dates during the month in which the case was actually open.

List dates of weekly contact with CA social worker (if your contact was more frequent, you only need list 4 or 5 dates, one in each calendar week).

Leave the date of termination blank until you submit the final Monthly Status Report—upon terminating services and closing the case.

Do not count forward 6 months from the referral date and enter that date; it’s actually fairly unlikely the case will still be open by that time.

The Table

The table on page 1 of the Monthly Status Report is fairly self-explanatory: it requests the dates on which face-to-face contacts were made with members of the family, and the length of each contact.

Even if the contact only lasted 10 minutes or was unscheduled (e.g., running into the client at the grocery store, where they proceeded to tell you some new development), include this…

…in 15 minute increments, of course!

Include both therapist and parapro family contacts, to provide an accurate summary of total number of face-to-face contacts and total amount of time spent with the family.

Add up the number of hours, and enter the total in the bottom row of the table.

The Narrative

In this section, each goal currently being addressed in the family’s Service Plan is listed, along with descriptions of goal-related activities that have occurred during the month and progress being made (or not) on each goal.

• State each goal as written in the family’s Service Plan.

• Under “Progress,” describe only those case activities related to the preceding goal, and progress made (or the lack of progress, if that is the case).

• Don’t forget to explain any use of Concrete Goods/Support Services funds related to each goal…

• …basically, you are providing the same justification for the use of these funds as you gave the social worker when you first requested them.

• Provide concise but thorough information related to goal-related activities and progress.

• Indicating, “Good,” “None,” or even something like, “Moderate progress has been made on this goal” is NEVER sufficient explanation!

• Provide pertinent details to support your assessment of progress made or lack thereof.

In the “Comments” section, include information that is not goal-specific (which would be listed under the appropriate goal) yet pertinent to the case, which the social worker needs to know.

• NOTE: The social worker should already be aware of most of this info, courtesy of your weekly updates.

Keep in mind that CA social workers frequently submit Monthly Status Reports in court cases…

…which means your reports are often read by many other individuals, who will assess your work based on these, and other, reports.

• So be professional, and do your best!

Financial Reconciliation Page

To fully understand FPS billing procedures, it’s perhaps most helpful to turn back to the Client Service Contract to review the pertinent definitions before we discuss them in detail.

According to the Payment Schedule in the FPS Client Service Contract, just about everything you do related to a case is billable…

…but let’s look at some specifics.

Direct Counseling Time

• This means any face-to-face contact with the family present.

• Regardless of the activity (counseling, shopping, waiting in a doctor’s office with them, etc.), if the client is with you and you are interacting with them, it’s billable under direct counseling time.

What if you’re in your car with a client?

Unless you’re chauffeuring them in your limo with the privacy screen closed…

…it’s direct counseling time, not travel time (but don’t forget to bill for your mileage).

Often, therapists find some of their most effective client interactions take place in their vehicle…

…a serendipitous benefit when it becomes necessary to transport a client for some reason!

Case-Related Activities

This category covers virtually any other billable activity performed by FPS therapists (except for travel and waiting).

Defined in the Client Service Contract as: “those activities that will impact the family but do not actually require the family’s direct involvement.”

The contract lists a number of examples of such billable activities:

• collateral contacts (either face-to-face or on the phone)

• attendance at CPT meetings or other formalized staffings

• court time

• report writing and general documentation

• supervision of paraprofessionals

However, there are many other common case-related activities (for example, participating in a case conference) for which you may bill.

Rule of thumb: if an activity is specifically related to a case in some way that will assist the family in accomplishing the goals of their service plan, you may bill for it.

Traditionally, the category of Case-Related Activities has been divided into three specific areas:• Collateral contact

• Paperwork

• Other case-related activities

Let’s examine these sub-categories more closely, to ensure a full understanding of each.

Collateral Contact

This refers to phone calls and/or face-to-face meetings with social workers, school personnel, attorneys, probation officers, etc., made by the FPS therapist when the client is not present.

• If a client is present during any of these activities, the activity is billed as direct counseling time.

• If the client is present when the therapist is speaking with the referring social worker about the case, this may also be counted as a weekly case update, though billed and tracked as direct counseling time.

Collateral contacts include contact with the referring social worker and with anyone for whom you have a release of information, who is not an actual family member (unless it is extended family not living in the family’s home).

You will most likely have more collateral contact with the referring social worker than with anyone else (particularly since weekly contact is mandated),

so be sure you are both documenting and billing for these contacts!

What about phone calls to/from client family members?

A slightly different situation, phone calls to or from clients—generally, the referred family, identified on the referral form and living together in the primary residence—are considered neither direct counseling time (not face-to-face) nor collateral contacts (which category only includes non-family members).

An important word (or four) about client phone calls…

1. They are not billable.

2. They are not billable.

3. THEY ARE NOT BILLABLE!

(really!)

Despite what you may have heard from a social worker, a colleague, or even your supervisor, the FPS Client Service Contract does not allow providers to bill for phone calls to/from members of CA-referred families.

• Not even in emergency situations.

• Not even when a phone call, as opposed to a face-to-face meeting, is clinically indicated.

And we’re not just talking phone calls here; communication with the client via any type of electronic device (e.g., e-mail) is non-billable…

…with one important exception:

if the client must use such equipment as reasonable accommodation for a disability.

So for all intents and purposes, just remember:

Phone calls to or from a client are not billable!

Paperwork

“If it isn’t documented, it didn’t happen!”

A bit dramatic, perhaps, but the importance of completing FPS paperwork (and on time) cannot be over-emphasized!

The term “paperwork” refers to all documentation related to an FPS case:

• Charting notes

• Family Assessment

• Monthly Status Reports

• Exit Summary

• Any other written reports which might be requested of you (such as court reports)

Requirements related to these specific types of documents are outlined in the “Deliverables” training, and will not be repeated here, except as related to billing.

Special notes on billing for Family Assessments

• When meeting with a family and focusing on assessment, this is billed as direct counseling time.

• When scoring the NCFAS/NCFAS-R in your office, or actually writing the narrative Family Assessment, this is billed as paperwork time.

Special notes on billing for Service Plans

• When developing goals and objectives for the Service Plan, since all work is done together with the family, this is billed as direct counseling time.

• When typing the completed plan before getting signatures and sending a copy to the social worker for approval, this may be billed as paperwork time.

Bill only a reasonable amount of time for paperwork, even if it takes you much longer to complete.

For example, the first time you complete a NCFAS/NCFAS-R, it may take you an hour or more—but a reasonable suggested amount of time to bill is about 30 minutes.

Other suggested amounts of time to bill for typical documentation:

• Average Charting Note (depending on provider’s required format): .25 hrs

• Average Monthly Status Report: .5 hrs

• Average Family Assessment (not including scoring of NCFAS/NCFAS-R: 1-3 hours, depending on format and thoroughness

• Average Exit Summary: 2-3 hours

Q: Why might a provider want to bill less time than is actually spent on paperwork????

A: Because, realistically, the more hours we bill for doing required documentation, the fewer hours we have available for direct face-to-face contact with our clients.

You may not bill for agency-required, non-client-specific paperwork, such as filling out your timesheet or agency mileage reimbursement form, developing an on-call schedule, etc.

Your agency may or may not pay you for these activities—but CA will NOT compensate a provider for any activity not directly related to a specific case.

Other Case-Related Activities

Primarily used to classify such activities as meetings, staffings, and supervision…

this is essentially a catch-all category which, on occasion, may tend to overlap with collateral contact.

Typically, meetings/staffings refer to scheduled meetings with otherprofessionals involved with the case, e.g.:

• Social workers

• School personnel

• Probation officers

• Attorneys

• Psychotherapists, family therapists or other counselors, etc).

Meetings/staffings could include:

• CPT’s (Child Protection Team meetings)

• Multi-disciplinary team meetings

• Child and Family Team meetings

• Any of the specialized staffings listed under “Case Meetings” in the Client Service Contract

Family members may or may not be present…

…however, when family members are present in a staffing or other meeting, it makes sense to count such meetings as direct counseling (i.e., face-to-face contact) rather than as a case-related activity.

Other activities included in this category:

• Case consultation

• Clinical supervision (therapist obtaining supervision)

• Supervision of paraprofessionals (therapist providing supervision)

• Court time (if providing testimony; if sitting/interacting with client, that would be direct counseling time)

All of the types of services discussed so far comprise the billing category of “Therapist Fees.”

The FPS Client Service Contract lists the various billable services, along with the hourly rate at which providers will receive compensation for services rendered to FPS clients each month.

Case-related Travel

Unlike many other service contracts, the FPS contract allows providers to receive reimbursement for travel related to the case.

Travel time is billed at one-half the

therapist fee rate.

• It covers the actual amount of time spent in traveling anywhere related to a particular family…

…so it is important to record your departure and arrival times to calculate travel accurately.

Allowable travel time is “portal-to-portal,” which means from your parking

space to the family’s front door.

Always be sure to fully document the reason for any excessive amounts of travel time, such as:

• Unusually-long traffic delays/detours

• Adverse weather or road conditions

• Other unforeseen occurrences.

The FPS contract also allows providers to bill for waiting…

• for a client who is late for an appointment,

• for a client who is in court while you wait outside,

• for a client who is seeing a doctor, etc.

Time spent waiting is billed at the rate for travel, or one-half the hourly therapist rate.

• Use good judgment—while you may have no choice but to wait 3 hours in court, you probably won’t want to sit in front of a client’s house more than 15 or 20 minutes if they’re not home when you arrive for a scheduled visit.

Sometimes, while waiting, a therapist can put the time to good use—making phone calls, doing paperwork, etc.

That’s great if you can do it…just be sure you don’t double-bill.

• You cannot bill for two activities at the same time (e.g., you can’t bill a case for both waiting and calling the social worker at the same time, even if that’s exactly what you’re doing!)

The contract states that no reimbursement for travel shall be paid outside the county where services are provided…

…so if your catchment area includes more than one county or if your ability to provide services to a client necessitates inter-county travel, you must obtain approval for this in advance.

Paraprofessional Fees and Travel

Although parapro services are classified and tracked in the same categories as therapist services,

There is no distinction between the fee for services such as face-to-face contact or paperwork, and travel.

Everything a parapro does is billed at a rate equal to 1/3 the therapist rate.

Stated another way, for every one hour a therapist spends with a family, the parapro could spend three, at the same cost—for every 2 hours a therapist drives, a parapro could drive 3.

Thus, using parapros is an extremely cost-effective way of providing families with more FPS.

Like therapist time, the parapro’s hours of service are documented to track how much time was spent providing each type of service.

Because of the difference between therapist fees and paraprofessional fees, these are recorded and calculated separately.

Mileage

These are actual miles traveled to, from, with, or otherwise related to your work with a client.

As with travel time, mileage is calculated portal-to-portal, the shortest route between the two points.

Record the distance to and from a new client’s home, then use that figure each time you visit them (unless, of course, you meet them in different places, transport them elsewhere, or drive to their home from a location other than your usual point of departure).

Because the mileage compensation is reimbursement for miles actually driven, take care in recording mileage carefully and documenting:

• Where you went,

• The purpose of the trip, and

• How it was related to client goal achievement.

Unlike the hourly rates for therapist and parapro services and travel, the mileage compensation rate is not actually stated in the FPS Client Service Contract.

Because of frequent fluctuations in the state mileage rate in recent years, the contract now provides a link to the state website that can be accessed to obtain the mileage rate for the date on which the service was delivered.

Be on the lookout for notifications regarding changes in the state mileage rate!

An alert fiduciary specialist might catch an error in your billing, but it makes much more sense to know the correct rate before submitting your reports.

You now know all the categories of billable services…

…so let’s look at putting it all together!

Completing theFinancial Reconciliation Page

Putting the Pieces Together, Step by Step

1. Total each category of services on your Client Service Log (the listing of hours spent in billable activities).

• Subtotal the amount of therapist time spent in direct counseling, collateral contact, paperwork, and other case-related activities.

• Total these 4 categories to obtain the total number of Therapist Fee hours.

2. Total therapist travel time, and therapist mileage on the Client Service Log.

• As with the other categories of therapist services, list these totals on the Client Service Log, in preparation for fee calculations.

3. Subtotal each type of service provided by the paraprofessional, if applicable.

• Then add together each category (direct counseling, collateral contacts, paperwork, other case-related activities, and travel time) to obtain a grand total of Paraprofessional Fee time.

• Also total the parapro mileage.

4. Complete the heading on the Financial Reconciliation Page.

• This heading contains most of the information already provided on page 1 of the Monthly Status Report, so this part is easy!

5. Locate the first table, labeled “Counseling Services,” and find the column headed, “Hours.”

• Drop down to the blank box next to the line that says, “Therapist Fees @ _____/hour.”

• Enter the total number of Therapist Fee hours (from the Client Service Log) in that box.

6. Multiply the number of Therapist Fee hours by the hourly rate.

• Enter that result in the next column, “Cost.”

7. Enter therapist travel time in the same table, under “Hours.”

• Use the row labeled “Therapist Case Related Travel Time at _____/hour.”

• Multiply the number of hours times the hourly rate, and enter that result under “Cost.”

8. Enter the total number of parapro hours, including all services and travel, in the same table, under “Hours."

• Use the final row, “Paraprofessional Fees and Case Related Travel @ ____/hour.” Multiply the number of hours times the hourly rate, and enter that result under “Cost.”

9. Add the figures in the “Cost” column…

• and enter the result in the “Cost” column on the line labeled “Sub total.”

10. Add the number of miles driven by the therapist to the number of miles driven by the parapro.

• Enter that number in the second table, under the column headed “Total Miles.”

• Multiply this by current mileage rate, and enter that in the column headed “Cost.”

11. Add the subtotal from the first table to the figure in the “Cost” column on the second table.

• Enter this figure in the “Cost” column in the row labeled “Grand Total for SSPS Code 2580 Authorization.”

12. List any Concrete Goods/ Support Services expenditures in the third table. (labeled “Concrete/Other Services”)

• Total these expenses in the “Cost” column in the row labeled “Grand Total for SSPS Code 2581 Authorization.”

For specific details on using and obtaining reimbursement for the expenditure of Concrete Goods/ Support Services Funds, please refer to the handout by that name, included in your packet of training materials.

13. Update running totals of the amounts of funds available for each case.

• In the final table, enter the Grand Total for SSPS Code 2580 Authorization in the “Payment This Month” column, in the row labeled Month 1 (assuming this is the first month of service).

• Subtract this figure from the total amount allotted to each case, and you have the amount of funds remaining to work with this family.

• Enter this figure under “Running Balance for Counseling Services.”

• Follow the same steps to obtain the “Running Balance for “Concrete/Other Services” (Concrete Goods/Support Services)

Save the completed Monthly Status Report electronically, so that when you do your next report, the headings, goals, and the running balances are already completed and necessary changes (dates, hours/costs, and goal progress) can easily be made to reflect the next month’s activity.

14. Print 2 copies of the completed Monthly Status Report—both the narrative and the Financial Reconciliation Page.

• Place 1 copy in client file, along with copies of receipts, if applicable.

• Attach original receipts (for any expenditures for which you are requesting reimbursement) to the copy that will be submitted to CA.

15. If this is the first month of service (first time a Monthly Status Report has been completed on this family)…

• …attach a copy of the CA-designated Referral Form for this family, showing that services were properly authorized by the supervisor.

16. Submit the following items to the appropriate regional Fiduciary Specialist by the 10th working day of the month:

• Complete Monthly Status Report

• Original receipts for Concrete Goods/ Support Services expenditures

• Copy of signed referral form (1st mo. only)

• Copy of Exit Summary (last mo. only)

If desired by your agency or by the referring social worker…

…submit a separate copy of the Monthly Status Report to the social worker.

• If you are not sure whether or not to do this, ask the referring social worker if they would like you to forward a copy to them.

That’s it!!!

That’s all you need to do!

FPS billing is a lot like riding a bicycle…it’s a bit challenging at first, but it truly keeps getting easier every time you do it.

Just remember…

• The Monthly Status Report is fairly self-explanatory, so you can probably figure it out yourself if you forget a step or become confused.

• However, if you do need assistance, please seek advice from a reliable source! A colleague, referring social worker, or even a fiduciary specialist might not have the correct answer.

Some better options:

• Refer to the handouts “How to Complete the Financial Reconciliation Page” or “Using and Obtaining Reimbursement for Concrete Goods/ Support Services Funds,” or

• Direct specific questions to the FPS Program Manager, CA Regional Program Consultant, or CA-designated FPS trainer.