Collaborate on Sickness Billing Format for Client for Organizations with Ease Using airSlate SignNow

Sickness billing format for client for organizations

to record now we are recording we are joined today by the wonderful marchella who has um agreed to tackle this exciting this exciting uh task of going over the most important aspect of Medicaid billing and that is billing Medicaid and next week we will be joined by Terry again I'm gonna skip over these slides we're all familiar with them we've gone through them every week um so next week is quality assurance and quality improvement and there will be another q a session on that Thursday November 10th for folks who joined the last q a session we got some really excellent questions hopefully it was helpful to the folks who join we really encourage you all to join again on November 10th and with that I will pass it over to Marcella all right thanks Eva thanks everyone for coming today and looking forward to today's conversation um as always questions come up put them in a chat questions we can answer quickly we will do so uh questions that um we can't answer quickly um we will take town and get those answers for you um both either send them out to you as part of this depending upon the level of detail or also go over it again in the Q and I session q a session that Ava talked about on the 10th um so happy November everybody um today we're going to be reviewing billing structures and processes we're going to talk about different billing options and when I say that I really mean what systems is your agency using to capture the information in order to create a claim we'll talk about the CMS 1500 form we'll talk about how to make sure that your Medicaid document that your documentation is Medicaid compliant and we'll look at some examples of documentation so all of these different pieces as you begin to set up what's called a Billing System the end of the day your agency has to to have this is covered in your policies procedures as well has to have a process and a system for documenting what it is you did what time your direct services staff spent with the people that they're helping get jobs and helping get in or sustain housing Etc um and then how does that threat sleep into a file that a mirror group can pay you for um based on the rates that we talked about in the earlier session so next slide please again always jump in and stop so when you when we did provider enrollment remember you made a choice when you completed the provider enrollment process you said this is how we're going to capture this information so I just want to link this back to the conversation that we had in session two when we talked about provider enrollment so next slide please these are the options of which we're aware of your agency may have your agency may be in the process of purchasing what's called an electronic health record or an EHR that usually is a broader comprehensive system that gives you a lot of outcome measures for uh your services um who you're serving with demographics that people are your survey helps you do an equity analysis there all of that all of the different both clinical care Clinical Services if maybe you're also a health center maybe you're also a behavioral health clinic as well as these Services uh the foundational Community Support Services you may also have just basically an electronic billing system this creates invoices for you this has to be HIPAA compliant and we'll talk a little bit about that today et cetera but something that just captures our documentation system and translates it into it's important to remember because the payment mechanism is different if your agency is doing supported employment you need a billing system that captures literally minute by minute and we'll talk today about what it means to fill a 15-minute increment and how many minutes go into a 15-minute increment because it's not as simple as you might thought um and then also what you have to do in order to be able to build a per diem because if you're doing Supportive Housing Services Under FCS that's a different system so you may have an EHR you may have a simpler electronic billing system you may have an agency that does this for you and you have to pay them to do the work so you may continue to document the way you've historically documented Etc and then that generates some kind of a file maybe a spreadsheet maybe some kind of documentation that goes to a third-party biller and that third-party biller creates a claim you may have your password protected spreadsheets um this is something that amerigroup's been directed by the state to allow but that's not something that most systems do allow at this point you may even have who the Wayback machine paper claims um but again that is at creating literally Staples will sell you for very little money you know a thousand CMS 1500 forms but I will say that that is really not recommended at this point um most of the HMO systems are not oriented in order to use that Americans doing that they're doing their best with it but it's not the way most of their system is oriented most of their system is oriented to capture we'll talk about an 837 PE file today um which lets them know what it is you've done and how they pay you for that so there are a couple of billing options you need to choose electronic health records billing systems third party billers password protected spreadsheets and like I said Wayback machine paper claims so next slide please so I'm going to talk as often I like these first slides let's get you through at a high level what everything is in this process in documentation and billing and then um and then we'll go into the details of what we mean by each of those so your direct services staff deliver the service I'm helping people get jobs I'm talking to landlords I'm helping people get into housing I'm helping them develop a Crisis Support plan I'm helping them Implement their Crisis Support land I'm the direct service Personnel are delivering the service direct service Personnel they'll either out in the field or back in the office come back and they document the service you may have a tablet you may have paper you may have whatever system you have but you document Marcelo was in the field with these people at this time from time a to time B you know from 10 a.m until 10 45 a.m and this is what we did it's going to be very important that that documentation in the service gets back to your service plan and it's clear from an auditor perspective that whatever it is that you were doing in that time you spent with the participant that it has something to do with what their goals are on their service plan there needs to be a process by which the documentation leads the creation of what's called a healthcare space a claim Healthcare claim is health care for invoice as what many of us who might have done grants in our systems as well and it has to follow a very strict format What's called the center for Medicaid and Medicare services excuse me or CMS 1500 form and there's a link to that form as well but we're going to go over that later today um your agents your claims will be submitted to availity that's the Amerigroup Clearinghouse electronically ultimately what this is an 837p file so if you're an electronic health record you have an electronic billing system that system has a way in which to take that documentation that you've created and create uh gets grabs the information that it needs to fill out the 1500 form and then creates this file which is what availity is looking for which is the 837p file um Amerigroup will pay your claims based upon approved claims if you submit your claims electronically they will send you back what's called an 8 30 5 file or an electronic remittance advice what it basically says is you submitted these let's say 10 claims in this file and um three uh 10 of them I'm sorry eight of them are good everything's fine uh Amerigroup is going to pay you for those eight claims there were issues with two of those claims and we'll talk about how to determine what those issues are and what issues can be resolved and fixed to be resubmitted what issues may not be able to be resolved Etc but they give you that back info information back in that 835 file you review what the unplayed claims are the reason for the lack of payment you figure out whether you can change that so that you can get paid for that service or you can't so for example um an individual who is not enrolled in the Day of Service not enrolled in Medicaid in the Day of Service that cannot is not a claim that can be paid there's nothing you can do to fix that um there are other things that you can fix if you're you use the wrong NPI number for your agency if you spell the name wrong if you know the prior authorization number that you put on the claim was wrong etc those things could be fixed resubmitted and then hopefully paid out your agency will adjust um and resubmit claims and hopefully get paid for all if not most of those claims you'll get a payment as was set up in the contract with Amerigroup that's the your billing units of service under supported employment 27 for a single unit of service or 15-minute increment um and then per diems I think it's 112 but we've got to slide on that later for Supportive Housing Services your agency should have a process built in here where you review to ensure compliance and sustainability um you need to have a process by which you know what got paid and you're able to work with your direct services staff they may have productivity requirements and you let them know what's meaning what claims are meeting what's not if they're common mistakes that you're making you work to fix them obviously this process of submitting and resubmitting claims uh delays your agency's payment that's not something we want so this is the big picture overall process I'm going to get in to some of the details now next slide please oh I also want a shout out I see we've got Jacob Avery from Amerigroup on here um so Jacob as always please feel too free to jump in you folks are the ones that are doing this work every day and working with the agencies so if I misspeak anything or you want to add anything please jump off and tell us uh though most of this is from the Amerigroup provider manual whoever your agency is going to be doing the billing needs to spend a lot of time and be very familiar with the Amerigroup billing billing manual so basically this is just a screenshot of what's on page 37 of that provider manual um it gives you the information about availability that's the Clearinghouse amerigroup's Clearinghouse it gives you the payer ID where you would mail paper claims if you would use them but hopefully not um and just some information that you need in regards to availity all of this material is just grabbed from the Amerigroup provider manual and again if you're the billing staff or your agency you want to be really familiar with that and follow the rules and the guidance the easier um uh the more detailed this is a very detail-oriented person job but the the correct you get this information um you know the quicker that you will be paid so next slide please excellent next slide okay Clearing Houses what's a Clearing House Clearinghouse in this case for managed care is a separate entity that is basically taking electronic data information or EDI electronic data interface or EDI it's grabbing that 837p file it's looking at it and saying does this have all the information we need is everything done right here can we make a recommendation to the actual MCO Amerigroup in order to pay based on these claims they aggregate the electronic information they make sure that the claims work is submitted securely and accurately availity is the uh Clearinghouse that Amerigroup is using um and again this is just one more time where I have to shout out to the healthcare Authority for you know having the third party administrator model I'm working with agencies in Minnesota and North Dakota where they're working with multiple different agencies multiple mcos multiple clearinghouses that this is one Clearinghouse that you work with one account that you've got to set up one agency you know one MCO that you're working with and they're working hard in order to onboard providers oh it's just a really really valuable model here to make sure everyone can sign on all right so that is the role of a Clearinghouse so you'll be working with availity um Amerigroup encourages electronic claim submissions we do too that is definitely the future um but they are also willing to work with all the providers um you need all of this information particularly the procedure codes for that CMS 1500 for we talked about Supportive Housing Services the procedure code of 80043 it's a per diem you can bill up to 30 days in 180 day period unless you have an exception the rates are there pre-employment services employment sustaining Services you see if agencies are in pre-employment you have a different procedure code than if they're an employment employment sustaining so it's important to know and have the prior authorization from Amerigroup for each of these Services each claim also requires that prior authorization number claims that do not have a prior authorization number that matches the agency's information and the individual's information are claims that availity will reject um and you can work with your Americorps FCS manager for additional support on this process it's also more materials help more details on this this is where I got all this information from from the Amerigroup website in regard to this question let me just take a moment because this is very precise very important information and Jacob anything you or anybody else from America group wants to add here all right all right jump in at any time but next slide please you heard me use one of as we're learning here Healthcare is a lot of different acronyms one acronym you're going to hear in the billing space is something called electronic data interchange your agency and provider enrollment has made a choice about how you will do electronic data interchange and we've got more details on some of these process in this slide deck from Session One uh you submitted this information not only to HCA as part of getting your provider One account you also submitted more of this information to Amerigroup a mayor group needs the same information you need to tell them for your contract for your agreement um with Amerigroup how you are doing your EDI and again these are the same options we had before you may have an electronic health record you may have a Billing System you may have a third party biller you may have worked out another process with EDD uh for ADI with your foundational community supports manager at Amerigroup Etc but it's important that you have this worked out and when you um I'm not sure if contractors the right word but when you set up your agreement with the mayor group that you have all of that information um there and this is the process that you are going to follow if you change that process Etc you need to be in touch with your FCS Foundation manager and they're going to need that information they're expecting data and information to come one way through one path for you they've got their system set up shall we say when you're pitching for them to catch Etc um if you're changing how you do that you're going to need to you're going to need to let them know all right uh so yes so next slide please so one of the things we talked about was for the sport of employment providers is billing in 15-minute increments these are all federal requirements here remember I said 15 minutes isn't what it used to be um when you Bill for one what's called unit of service that means that a direct service professional has spent anywhere from 18 minutes to 22 minutes with that individual you spend less than 18 eight minutes with them you are not eligible to bill you have to spend at least eight minutes with people um and for the 15-minute increments for one unit of service if you're 18 minutes of service 15 minutes great then you've got to get another eight minutes in before you're billing for a second unit of service so 8 to 22 minutes you're billing for one unit of service under supported employment that's the 27 rate um when you've seen people from 23 minutes to 37 minutes you are now billing for two units of service um and then when you see people from 38 minutes and 52 minutes you are billing for three units of service there each of those units of service is under that twenty seven dollar rate and you may want to grab this slide for training for your staff it's very important they have to document um the time they spent with people uh the direct service the face-to-face time Etc and it needs to bill in these 15-minute increments um you also your systems need to be set up so that the systems can tell oh Marcelo was with um Ryan from um 10 o'clock until 10 45 that is 45 minutes that's three units of service because what goes on that CMS 1500 claim form is how many units of service that you are billing availity in America group for so I think just a really helpful detail there for agencies next slide please so people often ask us hey should we get a lot of electronic health record is the investment worth it as CSH does not endorse any one um one system over another but let me but let us say this one you should talk to people who are using that system every day I'm a full-time consultant now I'm not using any of these systems you shouldn't listen to me you shouldn't listen to anybody who's not using these systems you should always listen to people who are using it every day you should have a startup period with them where you're learning the system you should see how much of this system is customizable how much does this interact with your other systems you really want to make this system as easy as possible you want your direct services staff to be focused on delivering quality services not on messing with your electronic health record you should have a process before you even go to looking at electronic health record you should have and develop a workflow talk through your internal process does it make sense from a quality services point of view develop a documented workflow that takes from Service delivery to documentation to Billy have that to start your conversations with potential vendors take recommendations from your friends and neighbors who are using these systems discuss with your team what you want what you need discuss with different members of your team discuss with your direct services staff discuss with management discuss with development because development's going to be trying to grab information here in order to you know get additional funding for your services and programs Etc what information do they need if they want to be able to pull out of their electronic health record think big and scale back as needed sometimes there's a big capital investment needed for this sometimes the uh systems will um set you up for a long-term uh percentage of your Medicaid billing record so you may or may not need that initial large capital investment schedule time with agencies who already use a system to discuss the pro and cons learn what the software does without any what they call out of the box not any individualized tailoring to your agency and then what individualized tailoring might you want what would that cost what would that do to your time frames Etc what ongoing support is offered well Customer Support Services is offered that's really really important get estimates and schedule test runs get references and compare what it is you get from the cost CSH has done for our work in Minnesota um housing stabilization Services is what FCS is called in Minnesota and we've got a link here to our guidance on HIPAA HIPAA is a federal law so it's very um uh so it's very similar to what it is that you require HCA is requiring your agencies to deliver a to be a HIPAA compliant either an agency what's what's called a covered entity or also in the hippo world what's called a hybrid entity hybrid means this department this office is all doing the FCF Services that's HIPAA compliant this office May over here may be running straight Outreach or a shelter or not building Medicaid for that so we're not hip applying over there but the data systems any data system that touches your FCS related records is going to have to be a HIPAA compliant data system so the guidance on here um it can be I think really helpful um get past the HHS language every time you say HHS HSS put in FCS and you'll be seeing the same thing and I believe unless Ryan tells me differently we're going to be working on adopting this um for Washington state for next uh for next year's work so I'm hopeful for that as well so just some things to think about and know that this is a thoughtful process know that this process is probably going to take to even pick an electronic health record to depict how your system is going to go is probably going to be at least six months build that into your work plans and your time flows and your time frames workflows and time frames get that next slide please all right we're going to talk about documentation we're going to talk about a big important phrase called medical necessity everything that is delivered under Medicaid and that Medicaid pays for there may be a requirement in regard to medical necessity uh Melanie hey Melody nice to see you um you want to know if we're going to talk about collateral versus face-to-face um I believe we do later and if we don't let's make sure we do because I remember having a conversation recently with Ryan on this all right and great to see you sort of um all right next slide no all right so as you look at your documentation systems you're doing you've been doing housing related services for a long time you're just starting a new system wherever you are in this process look at your documentation look at the current state of what you're doing with client charts look at the location and the security of client charts remember we should have to be HIPAA compliant those charts are probably going to need to go beyond a locked door remember you're defining medical necessity medical necessity is a constant conversation that says why does this individual need these Services why do they need these services at this level at this amount at this intensity uh we're going to talk about the golden thread the golden thread is basically the idea what's in the service plan has to be covered in your documentation um every chart every note should say these are my Cello's three goals related to her employment and here's how the activities that we did today got her closer to Meeting those goals that's the golden thread between the service plan and the documentation and that thread should be very very visible to any outside entity that's looking at your charts as you look at your reform your forms you may need make some revisions you may look at your intake and assessment you may now be asking for some different information what's an individual's Medicaid ID number what are they you know enrolled in Medicaid or not you're going to look at your individualized service plans you want them to be able to link back to that link that golden thread back you may have progress note templates or things that you look at and work with that you may want to change based on what we talk about today and what Medicaid documentation requirement is it and you may also have new quality reforms and tools you may have somebody whose job it is to go through the charts and make sure the charts are reflective are reflective of the work and match also what your documentation for billing that's going to be really important process as well we're going to cover some of that next time but as you start this process you want to look at your documentation and think about all of these things and think about what needs to change next slide please all right so medical necessity what's the definition of medical necessity you're going to hear that phrase a lot and here's what that term means when a person from Healthcare when a person from mcos uh an MCO like America uses that it means it's a profession of of services that is consistent and necessary with improving symptoms or a functional deficit why does this person need these Services why can't this person just go out a job a job on their own why can't this person just get housing on their own what specialized support are you offering why are those Services medically necessary in order for them to maintain their health first maintain their housing maintain their employment all of which supports their health remember Medicaid at the end of the day is an insurance program FCS is the Services Program Medicaid is the insurance program you're telling an insurance company this is why these Services aren't necessary for this person to be healthy it starts with a diagnosis of functional deficit you can have big conversations about not liking functional deficits but that really is the basis of Medicaid it starts with an individualized service plan that your team's adopted with necessary and appropriate goals that's where we get the golden thread for the documentation to the service plan and how those goals are helping people improve their functioning there's a reasonable expectation that the intervention that you're offered will improve the level of functioning again the goal is to help people be as healthy as they can and as always the documentation follows the golden thread so next slide please so as you're thinking about documenting medical necessity and as always you get the slides feel free to grab these slides and use them to train your teams um the client needs the service based on a diagnostic assessment here's what challenges the individual faces and why they need the service there's a clear connection again the gold thread connection with the service plan goals the diagnosis to the assessment these all fit in basic best practices and Healthcare today the writer and the progress note must explain the rationale tell the story why these services are necessary in order for a person to improve their health a reader must be able to sit back somebody who doesn't know the person who doesn't know your agency doesn't know the service but must be able to read that note and look back and say oh I can see the link I can see the golden thread between what's in the service plan between this individual's goals and what was done that day with them the progress notes are taught the service plan goals kind of same thing and the type and frequency of services are appropriate to the goals so this is in ensuring that if I'm helping somebody get identification if I'm helping them navigate that process I also link back to this person's looking for housing from an affordable housing Source they need ID in order to be able to do that we're helping them get that ID so that they will be able to access the housing their goal is to remain housed their income is very low they're going to need some kind of a subsidy for that and they're going to need ID to document the subsidy that really there is that thread between the person's goal which is housed remember be housed goal member goals can be very very high level and the little details of all the things we do every day to help them Reach that high level goal I like to think of those high level goals on a service plan it's also you know almost an umbrella a really big umbrella that we can fit anything it is that we're doing to assist people under that umbrella so next slide please so here's just another example of the gold thread you've got your support of housing or your support of employment assessment you've got your individualized service plan that says these are the functional deficits the individuals have I know it's not very strengths based it's Medicaid it's foundations in the system I just want to shout out not liking it but that's the way the system operates based on the individualized service plan services are delivered services are documented by a progress note and then those progress notes are reviewed in the quality review process in each of these you can see that golden thread from that initial assessment what Marcella's goals are for herself and her life and through each of these pieces of documentation so next slide please and I believe the state has a lot of kinds of golden threat a lot of training and supports on that golden thread idea as well so documentation let's talk about those assessments let's talk about those service plans we've got some examples of them that we're happy to send out to agencies if you don't have one um feel free to to grab and adapt for your agency next slide please so what's going to be important for for each of these is that under foundational community supports one you consider eligibility why is this person eligible for foundational community supports for supported employment they have need to have complex Health Care needs or some kind of Health Care related need and there are risk factors that make it difficult for them to maintain employment the employment assessment also includes that they have an interest they're interested in a job they want it they want to work that's part of their goals etc for their lives current employment status they may be unemployed they may be underemployed what their current income is what they're looking to increase that income to um housing stipend homelessness status you want to get that in there as well even though this is under supported employment and what are their strengths and barriers what's going to make it easy for them to get a job what's going to make it hard for them to get employment and how is it you're going to support them uh very similar in support of housing you need the complex Healthcare complex needs social needs Health Care needs um that they're experiencing homelessness they're transitioning from an Institutional setting um or that they're using a res um they're coming from Residential Services they've had a lot of change in residential services they've had a lot of housing instability you want to document in your initial assessment how and why a person is eligible for the services based on the eligibility requirements and then again all of this information for the housing assessment what's their employment status their income housing type or are they experiencing homelessness oh thanks for the golden thread training training Ray I appreciate it personal information related to housing uh placement and housing history again you are making a case for why these services are medically necessary for an individual to reach their goals around housing or employment these are all part of your initial assessment and as you look at your initial assessment what I would do is is basically take here's your initial assessment and say is this cover you know create a checklist all of these covered in the assessment if they're not for this program as we develop an FCS program we're going to need to design we're going to need it's easy to either add some questions or redesign our assessment process so this so how does an sud diagnosis play into this well an sud diagnosis is one it helps you be accountable for that um so that would come under complex needs complex Healthcare needs at the end of the day it's going to impact and you're going to want in the assessment understand how does someone's substance use impact their employment status impact their housing or homelessness status and impact what services and supports you need to give them in order for them to be successful in days depending upon wherever they are in relation to their substance use um so are they in contemplation stage are you taking a harm reduction approach to this are they an early recovery are they in maintenance phase Etc you think about all of those pieces into it and integrate that into your assessment when I say health needs I'm you know really big broad again umbrella metaphor here you want sud you want mental health you want Primary Care you want physical Mobility you want to understand all of those things because all of those health related needs impact a person's ability to work impact a person's ability to be housed get housed and stay housed and impact why people are probably going to need your assistance in order to do that that's why people are eligible for the program Sherry I hope that answers your question and thanks for jumping in good chat with the question all right so that so you're looking at your assessment and making sure that these things are covered good sounds good all right next slide please so service client compliance how do we make sure that we're putting together service compliance that can be covered by a Medicaid service next slide I'm sorry no desk here we go okay here are just some factors that a Medicaid compliance service plan will cover you know what bring them all up Eva because I think it's it's one of those every little block here Etc one um the service plan demonstrates the need based on the assessment you've made the case that because of a person's challenges they're going to need extra assistance to get housing to get a job their client needs your services will help them improve symptoms and their functioning um if there are problems and barriers related here they will be addressed Marcella doesn't have identification but we're going to work with you through that process to get our identification that will help her both get housing and employment um there are clear measurable goals there are steps that you can be um judged against should I say um you have that high level goal which is basically an employment related goal or a housing related goal but you also give smaller steps um that all of the things that you do to take you from here to there you give smaller objectives to reach their goal again these are all trackable um these are all uh you know measurable and these are all reportable um you highlight the strengths of an individual um gosh every time I worked with someone with long-term experience of homelessness or unemployment the strengths that they've had in order to survive um is amazing you build up those strengths you highlight those strengths you've got really clear timelines you think that you can get their identification you think that you can get their High copy of their high school diploma you can get their resume writ in this period of time and then move them towards the process that doesn't mean you have to that doesn't mean if it takes longer that's fine but you're going to have to justify that and understand why oh we thought we could get this person ID in two months and then it turns out they don't have any documentation whatsoever and they're from it's just something in my own City that happened a lot and they're from their birth certificate is from Puerto Rico but we found it took about nine months to get a birth certificate from Puerto Rico so that messed up our timelines but we kept working on it we kept supporting the person through that process um you know roles in response and why did it take that long I don't know it might have been there was a hurricane and everything was down but anyway how do I pick on Puerto Rico um roles and responsibilities who's doing that was part of your team who's doing what the person's doing this for themselves they're getting help with that you want all of that to be really clear again you want it to be reportable you want it to be measurable you want somebody to come in be able to come in and look at your service plan and say oh look this is all that's happened they are compliant with their service plan on these three areas in these two areas they're not but we understand why they've documented they found new barriers they're working through the barriers you're always moving forward what interventions you see and what progress and update all timelines can be revised interventions can be changed as always if a person wants something different you change the story yup everything's taken crazy long since for you okay I just wanted people to know I wasn't just particular God hey you know an incorporated space so thanks Sherry I appreciate that so yeah so progress and updates so yeah see all of this you want to be have in place in your service plan again you're thinking about this both from equality how do you ensure quality services but you're also thinking about it from an audit perspective as a Medicaid service people may be coming and auditing people with no knowledge of you no knowledge of your staff no knowledge of your program specifically just a broad knowledge of FCS have to be able to look at your materials and say oh I see the golden thread I see how people are moving forward to housing and services and things like that the next slide please all of these factors again everybody's going to get the slide deck you can use that to look so what are Best Practices service plan quality you want to include housing stability and housing eviction prevention in your goals they're coordinated with other providers you want to avoid duplication you want to avoid retraumatization we know Health Care you go to four different Healthcare Providers they all ask you the same questions you know that's what I mean when I say re-traumatization people have to tell their stories so many different times to so many different people as much as possible you want to minimize that um serving service plan goals or a living breathing it's used if it changes it changes that's great it shows you're working with a person it shows they've reached a goal you're looking for another goal it sets the framework for services they're strengths based uh meaning you know you highlight what people at the survival mechanisms people have had you highlight what they're really good at you give them that support in that way services are all voluntary to reflect the client's own goals one place and this is really important is language I've seen so many service plans where so and so wants to be medication compliant I promise you no no normal person in this world who doesn't work in healthcare uses the phrase medication compliance you want it to be in their language you want it to show that they've really been a part of this conversation and that they've moved that and that they you know they've created the service plan this isn't something we handed them Auditors also look at shoot does every you know service plan have the same three goals um phrase exactly the same way that's kind of ticks offer I don't think this is the these people's language and what they really want I think this is what the agency told them so these are all really important things you want to make sure it reflects their own recovery goals their voice is reflected in the plan the goals are created with the client not for at the client and the goals are reviewed with progress and barriers noted and new goals are established and how you're going to get through those barriers in some ways you're never done um even when somebody is maintaining housing maintaining employment you may have a crisis plan people's recovery Journeys are are non-linear what I would say and you always have to be ready for stressors of daily life and the challenges that can come there so these are all just things to think about and again feel free to use as your training your staff as they're creating those service plans for how to think about best practices and creating a service plan so next slide please this is just an example and we'll be able to send a copy of these if your agency doesn't have a Services plan this is just an example of one you can take it uh screenshot of this and use it again if it's helpful um go for it um nothing you know CSH again it's not requiring anything we don't have any Authority here but these are some of the best uh you know as we've done this training in many places across the state across the state and across the country this is you know a good example of some of the best of the work that we've seen here we also uh very quickly shared over email and have added to the SharePoint folder for session five a SDS version of an individualized service plan for you guys to use and adapt exactly again for all of these materials our goal is to make it easier for you nobody wants to start from scratch download adopt as data set adopt it for your agency back slide please so documentation let's talk about progress notes just a couple of slides one you want to make sure that this is a billable progress note an auditor needs to be able to look at a claim and say oh this agency billed for November 1st 10 to 10 45 services for marchella um I need to go look at the progress note that says that and so that I see that that matches so here's all things that need to be included in a billable progress note that supports your client the date of service because remember your claim submission has a date on it the start and end time for supported employment because remember you're billing on units of service out depending upon how much time you've spent with them that will impact your units of service for Supportive Housing because you're building in a per diem you want to have the total time I spent 50 minutes with this person I spent two hours however whatever that amount of time is um you want that total time there the location is it in the community let me go back to Melody's question about face-to-face versus collateral um let me say my definitions of understanding it and I 90 sure I'm gonna get this right and now Brian please jump in if I don't Face to Face Time Direct Services time is billable time remember we talked I believe it was session three where we talked about doing time studies for supported employment you're looking at how much of your staff's time is billable so that you can do appropriate Revenue Productions that's face-to-face time collateral time is time when I may not be with the individual but I am doing an activity that is based on uh that service plan and that goal so I am calling a landlord and working with them I have a release of information of course I'm not calling it a landlord about a client without that release of information I'm stopping by a job and talking to a person's supervisor there that's called a collateral contact I document that contact and you can correct me if I'm wrong man you can bill for that though that cannot be all I believe there's a limitation to how much of your contacts have to be um face to face um I believe it's a 20 could be 25 Grand do you remember these details oh should we look them up yeah I'm not I'm not incredibly confident about the amount but you're absolutely right on the collateral purpose and the the biggest point is just to make sure that it's you know a service that's um easily tied back to one part of the Pint um and then you you explain or have somewhere in there why the participant wasn't there why did you provide that service without the participant present with you um to make sure that it's it's just clear um and then of course yeah if everything you provided was collateral you you likely going to get flagged in some sort of audit forgive me for forgive me for liking on this and thank you melody for reminding me um uh that this is all in the American provider manual um so yeah I think when Eva closes us out I may go look it up so yeah um face to face as in person or a zoom meeting I don't know that that's been determined yet when I say face to face I mean in person I do not mean a zoom meeting um this is the question around Telehealth and we would have to do a little bit of digging or Jacob or I don't know if anybody else is on from America group if they know the answer to this question if you're doing a zoom meeting with someone that is considered Telehealth I can help with this for um for FCS versus uh things like Zoom or any kind of video conferencing secure video conferencing a meeting is considered face to face um and uh you can also um Folk as I just heard face face what is uh you you are able to build phone calls for SCS even though face to face is yeah Jacob you were coming in and out could you could you put just a little something in the chat on this just because you came in and out I missed some words and precision is all of all of this in this question possible I I will yeah yeah cool awesome thank you let me also say and Jacob you may put this in some of your answers as well is that there are rules right now they're fairly flexible rules as long as we as a country remain in the public health emergency it's not clear up for FCS Services video conferencing is considered face to face and that means it's billable time so yes um what I'm not sure and we'll have to do some look up as well is whether the flexibility some of that flexibility will go away when we are no longer in the public health emergency right now we expect to be in the public health emergency until at least mid-January what I will also say is that uh face-to-face is considered preferred telephonic communication is also billable that's from Jacob in the chat just wanted to say it because that's really important that you get that information um oh they're actually preceded Public Health emergencies okay so Jacob do you not think that this is going to shift when we get out of the public health emergency I know states have a lot of flexibility at around Telehealth and there's conversations at all sorts of levels State national levels about what what if those flexible flexibilities will remain when we get beyond the public health emergency so yeah so yeah a little rabbit hole but an important one for agencies here um what else is in the progress note the client name the goals that the service activities are related to yep okay thank you Jacob there'll be changes at the end of the public health emergency which we expect probably in early 23 but not sure uh watch your news for that one but not around the above issues that's helpful to them thank you um so the description of the service intervention what did you do what was the client response what was progress what was next steps um you know it always has to a service note really never stands alone it links to the service plan it links to the next progress note always links to your assessment um a dated signature from the individual and a title of the service provider that the service is medically necessary that's always a good line of service data is within approved and valid service plan dates texting with clients I have not seen an answer to this I will tell you Sherry the first thing I would do is go to the Amerigroup provider manual and look and see if there's anything in there in regard to his texting aloud but if anybody wants to jump in and answer that one I would be grateful that's a good question Sherry so yeah and I'm going to keep talking which is why I'm not able to go Google the provider or grab the provider manual actually lives on my desktop because it's really well done and there's a lot of detail in there all right so next slide please we're talking about progress nodes not going to go off fangirl on the web provider manual which I totally could um okay what are you doing you're focusing on the intervention and the services rates it relates to your goals you're using simple plain language it's always good to have a couple of client quotes in there you're summarizing the event and the intervention succinctly but therapy you're demonstrating you spend enough time with this person to accomplish the therapeutic intent you didn't go hey pay your rent and walk away and no one it's definitely not going to be eight minutes and two they probably need more than that if just a little reminder would work they probably the service wouldn't be medically necessary so make your case um oh Jacob this is from Jacob the folks can't see the chat texting an email are billable only during the PHA if this is the main form of communication you need to let a merit group know so we can add it to the main the list that they maintain on the behalf of HCA I think we really want to be clear that HCA is looking for the majority of your services to be face to face in person um but if there is a request from an individual but client choice is the primary underlying value here Etc um so we want to make sure that that's uh sometimes those two can be intention I just want to just want to hold that up um but yes and says I was like texting an email billable but only during the PHA uh the client's signature could not be digital how is this best documented it absolutely can be digital to going to have to take people through the process of a digital signature and work that out for them and most systems that I'm aware of now they use tablets they um and they have people you know click on things their digital signatures in their electronic health record this is another reason why you might want electronic record or Billing System yeah um so so you need to document that and Jacob's saying again there needs to be reason face-to-face Services aren't possible for the particular enrollment you need to document that change oh here's a good suggestion from Leanne thanks Leanne I want to include who's going to perform tasks and the progress notes for accountability purposes yep that helps from an auditing perspective that helps from a supervisory perspective so yes um you want to include the quiet response you always want to include quiet quotes client quoted two and a good progress note um you want to focus on the facts you don't want judgments here you want to say this is what happened you don't want to be subjective you don't want to be opinionated you want anybody who doesn't know this person who doesn't know you to watch and say yep that's what I saw too and you always want to have next steps in here and a plan for what the next steps are you're never sort of leaving somebody hanging you know when you're going to see them again you know what you're going to do with them you know you know they're on a path towards you know thriving in the community and what are the steps they take in there you always want to have that Vision First in front and center when you're writing that progress note so next slide please so one of the things we said is justifying time spent uh demonstrate and this is a quote from the last slide sufficient demonstration to accomplish the therapeutic intent you want to think about the symptoms that are present at the time of services um is there any training on being a non-biller um Connie I don't really understand that question um I don't know why agencies would want someone to be a non-biller um you would yeah that just doesn't make sense to me from an agency perspective um you want to consider symptoms and present at the time of service you want to integrate that in there what are people experiencing what are you helping them with do you want to think about clinical and best practice approaches used you may have folks with serious mental illness serious substance use disorder co-occurring disorders you want a lot of collaboration with their clinical behavioral health providers and you want to help trade and support your staff and working with people and you want to think about what's the impact that the service had on the individual how did it help them Reach their goals a caution to not pressure staff or productivity um we have seen too many cases too many sad cases where that led to staff who did fraudulent notes they make a two-minute call last eight minutes that's something it's also caught on Oda it's you really want to be sure that you've Justified the time spent um and you can make a case for why that extra time is medically necessary next slide please these are just some project notes examples the assessment the client has limitations around daily living schools specifically around regular eating and good nutrition the service plan goal is to maintain proper nutrition resulting in Better Health and housing and stability and this is this is what happened this is what this is what happened there's no judgment in here there's just to um uh as I gotta say there's no judgment here um there's just facts we went to the home this neighbor said they were asking for food which resulted of their neighbors which resulted in the complaints they reserved they have no food they help the person write a grocery list they took them to the grocery store to help them learn how to shop we discussed the importance of healthy food how to plan for meals case managers said that the client should be contacting the case manager instead of the neighbors if they run out of food Etc and this is what the client said and how the client felt about it they'll continue to follow up with the next appointment and talk about nutrition and eating and support and the client also said you'd call the case manager if she was running out of food or maintains help or needs help in this process many many times I spend in the grocery store when I was a case manager good memories next slide please this is just an example of how to do this you see there's no judgment here there's nothing wrong you know no judgments is really really an important piece of this person is ADD anxiety to cause them to be easily agitated when the boss gives them instructions they want to maintain employment so they won't have strategies to learn how to manage that anxiety and not overreact to the situation and again details what are the strategies what are the breathing techniques what are the thoughts how do you manage and control your thoughts and have respond so again what happened what did you do where did it happen how did it relate to the service plan and the assessment that you've done what you've done there Etc and then where are your next steps so again and again just some examples here again grab you can use in your own internal trainings um and I would say both use them in the internal trainings that you do for your direct services staff and then also say use them in supervision as examples if people are having trouble saying oh I went there and the place was a mess and everything was terrible that's the Judgment we don't want to see I went there and there were clothes on the floor and there was food that was rotted clearly there's an intervention that's needed clearly we're going to do some work around that because that's not a healthy environment and this is in many cases about their health so next slide please uh we and we are done I thought we had a little more but no we are so we're just about kind of the first hour I think Eva at this point I get to rest my voice and I turn it over to you absolutely well done Marshall thank you so much so um up next we've got the quality assurance and quality improvement session that's going to be with Terry next week and as I mentioned that following Thursday will be a q a I am going to stop sharing the slides and allow us to see hopefully some faces definitely some names and feel free to come off mute or type in the chat any questions you have for Marcella or Jacob or Rayanne about this session let me go ahead and stop sharing all right so what what questions do you have for Marcella and Company I'd love to hear from the group if you're already using a system for billing what are you using do you like it what do you like about it what's been good what's been not so good um and somebody who's not as far along in the process what do you wish somebody had told you three months ago six months ago Etc real life examples are the best is anyone using a Billing System currently Katie says we provide Case Management Services we do have face-to-face appointments to bill against for the hour the many of our contacts are on a daily basis less than an hour either on either on a referral call with other agencies or with the client and how to navigate a situation thanks for the comment Katie I'll just jump in uh real quick and um share a quick experience Bayside housing and services we're on the Olympic Peninsula um in Port Hadlock and Port Townsend Washington and we've just been providing transitional Supportive Housing for the last six years we're preparing to start our first permanent Supportive Housing program and so we're at the very beginning of this process beginning to um look at all our systems develop all this from scratch determine what our organization needs to grow into in order to be eligible to begin billing but in terms of systems um or case management and housing teams have been working uh on to get established on get help and um and then getting we're liking the fact that that integrates with hmis and helps to kind of put those two systems together so we've uh one thing we've really liked about them we've been working about with them for um gosh I think about eight months now eight or nine months and they've been very Hands-On and in terms of training our staff and so that's been really useful I can't offer much experience yet and because we're not billing yet but we've been very very grateful to their staff and to all of the really detailed like weekly sessions for many many months of training which has been fantastic is there a link to that um to that website Etc I can yeah if you can put that in the chat share with everybody that would be great Heather you bet thanks so much other um I see that Sherry wrote that um she said what EHR are folks using we're doing availity but expect to add me HR in the future or the ones that work better um and John responded with uh we do use availity but it's very time consuming does anyone know if there's a way to upload data to availity instead of manual entry and Jacob has responded with availity and other clearinghouses do provide options for batch billing this is probably the easiest way to build particularly if you have a large number of enrollees yes I can't imagine individual billing on availability the the if you get an electronic billing system an electronic health record what it will do is your staff are you know entering into tablets or their phones Etc you know clicking the client it will pre-populate this is their date of birth this is a social security number this is their Medicaid number this is their authorization number all of that needs to be here there are certain variables that you have to put in each time what's the date what's the time who's doing the service Etc um but then that creates that 837p file that availity can just capture it from a batch billing perspective Katie asks can we bill for cumulative services for housing for example spending 20 minutes a day times five days if documented so if documented yes the only thing that I would say here is remember that the services have a limit of what's called a service limit of you can only Bill 30 days at 180 day period if people need more time and more attention than that you can make a case to your FCS Amerigroup provider remember you're arguing for why is it medically necessary that this person needs this more intensive level of services what are the additional challenges you know beyond average that they make so that is possible but you do have to make that case um and live within that oh thank you heather for the GitHub platform um and then um and you should have a process that says um you know you should have an internal process that says okay you know for each client this is how 130 day you know these are the 30 days in this six-month authorization period gosh we're at day number 27 we're at day number 28 and we're two months out from the new authorization period what do we you know are we going to try to make the case do we think we can just see them a little bit you have to have a process that tracks that a process that thinks individually and clinically about each person and what their needs are um and then makes the you know makes the case from a billing perspective foreign so five daily housing supportive is five different days in a per diem perspective so you're billing for five days you're not billing one day a month first one day for a 60 Minute total contact you're billing for five days the issue is that you've got to spread it out across 30 days over six month period unless you make the case otherwise yep that's really important what Jacob said in here 60 Minutes is the recommended time our answer is 15 minutes is the minimum billable for a per diem unit and just reiterate what Jacob said any day you have billable FCS Services you are billing for that day you don't add up days over time so that makes that 60 Minute period these are all good questions it's a real shift for people to start thinking differently about billable time um billable time is and this is this is session three this is the time study work this is the time that people are doing things that are allowable under the service definitions that you're documenting and supporting and Jacob also responded that if you need additional units to provide your services you can submit an exception to rule request any other questions while we're all together all right well it looks like we all get about 55 minutes back oh where can we access the slides so um Keanu if you have already signed up for this training and have um if you're signed up for the training and I have your email address you should have received access to our SharePoint site where we are posting the slides where we are posting the recorded trainings as well as other materials if this is your first training that you're attending I may not have your email on file in which case um I will need to add you to the site it can take about a week to process I can also email you these slides so um if you wouldn't mind dropping your email in the chat or sending me an email an