iesbvi medicaid billing for part c developmental and orientation & mobility services presenter:...
TRANSCRIPT
1
IESBVI Medicaid Billing for Part C Developmental
and Orientation & Mobility Services
Presenter: Jim Donoghue
Medicaid Consultant
Iowa Department of Education
(515) 281-8505 [email protected]
August 16, 2013
IESBVI Medicaid Billing for Part C Developmental & O and M Services
IESBVI Medicaid Billing for Part C Developmental & O and M Services 2
End Point of Today’s Session
Items for You to Knowwill bill for Developmental & O
and M that you already provideEarly Access/Medicaid policiesexpectations of you: a) when
this will start; b) when/ how to identify the students; c) start to learn where/ how to document; d & e) communicate with IFSP teammates & Gwen, Pam, DE
IESBVI Medicaid Billing for Part C Developmental & O and M Services 3
Medicaid Background Remarks
What is Medicaid?
What does Medicaid have to do with Education Services?
What does Medicaid have to do with IESBVI?
IESBVI Medicaid Billing for Part C Developmental & O and M Services 4
What do I need to know about Developmental Services?•
EA Procedure Manual :
SI includes: 1) design of learning environments & activities that promote acquisition of skills…;2) curriculum planning . . that leads to achieving the outcomes in the IFSP; 3) providing families with information, skills, & support..; & 4) working ..to enhance development . NOTE: Resources Families Receive
EA Proc Manual Sect 1
IESBVI Medicaid Billing for Part C Developmental & O and M Services 5
What do I need to know about Developmental Services? (cont’d 2)•
ITP Medicaid Manual : Services include: 1) designing activities that help the child to..;2) modeling and teaching family members or care providers..;3) working with the child Covered services: 1)screening; 2) assessment; 3) developmental services to an individual..4) in a group..or 5)by contract provider
ITP Medicaid Prov Manual
IESBVI Medicaid Billing for Part C Developmental & O and M Services 6
What do I need to know about Developmental Services? (cont’d 3)•
ITP Medicaid Manual: cont’d: screening: brief assessment to identify presence of condition or developmental delay; identifies child’s potential eligibility for service & need for further evaluation; documented decision and rationale
IESBVI Medicaid Billing for Part C Developmental & O and M Services 7
What do I need to know about Developmental Services? (cont’d 4)•
assessment: comprehensive eval to determine child’s developmental level of functioning; from informed clinical opinion… through objective testing, includes 1) review pertinent records; 2) evaluate child’s level of functioning in six areas; 3) assess unique strengths and needs; 4) identify appropriate services; written narrative of evaluation and results
IESBVI Medicaid Billing for Part C Developmental & O and M Services 8
What do I need to know about Developmental Services? (cont’d 5)
•
direct services to individual, in a group, or by contractor: type and level of treatment direct outcome of assessment; services may be provided directly or through case consultation (monitor, supervise, teach & train professionals, paras, & parents in home or community providing general information and making recommendations)
IESBVI Medicaid Billing for Part C Developmental & O and M Services 9
What do I need to know about Developmental Services? (cont’d 6)
ITP Medicaid Manual
6 procedure codes, particularly
96111 Developmental Assessment, Extended,1 hour unit
96152 Health and Behavior Intervention, Individual, 15 minute unit
ITP Medicaid Prov Manual
IESBVI Medicaid Billing for Part C Developmental & O and M Services 10
What do I need to know about Orientation and Mobility? •
ITP Medicaid Manual :
• Vision services include: identification of range, nature and degree of vision loss; 2) consultation with child and parents ; 3) evaluation of effectiveness of a vision aide; and 4) orientation and mobility services
ITP Medicaid Prov Manual
11
What do I need to know about Orientation and Mobility?•
ITP Medicaid Manual (cont’d.) : O & M: Services provided to eligible blind or visually impaired children by qualified personnel to enable those children to attain systematic orientation to & safe movement within their environments in home & community; Code 97139 Unlisted Therapeutic Procedure 15 minute unit
IESBVI Medicaid Billing for Part C Developmental & O and M Services 12
What do I need to know about Orientation and Mobility?•
EA Procedure Manual : O & M includes teaching children the following as appropriate: 1)spatial & environmental concepts and use of information received by the senses to (such as sound, temperature, vibrations) to establish, maintain or regain orientation and line of travel;..
EA Proc Manual Sect 1
13
What do I need to know about Orientation and Mobility?•
EA Procedure Manual (cont’d.): 2) to use long cane or a service animal to supplement visual travel skills or as a tool for safely negotiating environment for children with no available travel vision;3) to understand & use remaining vision & distance low vision aids;& 4) other concepts, techniques and tools. NOTE: Resources Families Receive
IESBVI Medicaid Billing for Part C Developmental & O and M Services 14
End Point of Today’s Session (cont’d 2)
Expected of You to Knowa) when this will start: Oct 1;b) when and how to identify the
students involved: You will receive a list of students for whom you need to document; c) where and how to document: See example;
Ia Braille IFSP documentation example
IESBVI IBSSS Billing Log example
15
End Point of Today’s Session (cont’d 3)
Expected of You to Knowd) what communications are
expected of you with IFSP team: If shared visit, agree who will bill for specific time block
e) what communications are expected of you with Gwen or Pam if there are challenges: If challenges, make timely contact
16
If questions….
• If you have any questions after today’s presentation, please contact
• Jim Donoghue at (515) 281-8505, fax (515)242-5988, [email protected] or
Thank you for your interest.