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Case Management The Nuts and Bolts. Quest Case Management Services Case management helps provide an array of services to individuals and families in order.

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Presentation on theme: "Case Management The Nuts and Bolts. Quest Case Management Services Case management helps provide an array of services to individuals and families in order."— Presentation transcript:

1 Case Management The Nuts and Bolts

2 Quest Case Management Services Case management helps provide an array of services to individuals and families in order to cope with complicated situations in the most effective way possible. The goal is to achieve a better quality of life. The consumer identifies their goals, needs, and resources. From that assessment, the case manager, consumer and family come up with a plan to meet those goals. The case manager helps consumers to find resources and gets them connected with other services. Sometimes she or he advocates on behalf of a consumer to obtain needed services, and checks with the consumer to make sure their goals are being met.

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4 Case Management by definition Behavioral Health Case Management is a process that includes planned linkage, advocacy and referral assistance provided in partnership with a consumer, family members, law enforcement personnel, community agencies and other supports as defined by the consumer. This collaboration of services are to provide a continuum of care for persons who utilize services inclusive of, but are not limited to mental health, substance abuse, prevention or other services to support the consumer in self sufficiency and community tenure. Case management actions may take place in the individual’s home, in the community, or in a facility. An ODMHSAS Certified Behavioral Health Case Manager works with the consumer and their identified supports, in accordance with a treatment plan developed with and approved by the recipient and qualified staff to reach the consumer's goals to remain successful in their recovery.

5 The member/parent/guardian has the right to refuse behavioral health case management and cannot be restricted from other services because of a refusal of behavioral health case management services. Client services must be medically necessary Remember:

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7 Linkage Linkage – When a child/adult/ family (C/A/F) is in need of specific resource information, and needs assistance with linking up with that resource. [Billable time includes time spent locating the needed resource information, reviewing it with the C/A/F, and (with the C/A/F’s permission) communicating (verbal and/or written) with the referral source to make the linkage.]

8 Advocacy Advocacy - When a C/A/F is unable to successfully express their needs and interests and needs assistance with communication to access a specific resource [Billable time includes only the time spent on actual advocacy with the resource. This can include time spent on written communication (if assisting C/A/F with filling out forms, applications, etc. the C/A/F must be present), and verbal communication on the phone and face to face.]

9 Referral Referral – When a C/A/F is in need of specific resource information (such as a name, phone number and/or address) and can take the information and make the linkage and advocate for themselves. [Billable time includes time spent locating the needed resource information and passing the information on to the C/A/F.]

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11 Reimbursement SoonerCare (Medicaid) Reimbursable Case Management – Case Management services are provided to assist eligible individuals in gaining access to needed medical, social, educational and other services essential to meeting basic human needs. This includes referral, linkage and advocacy on behalf of the child, to gain access to needed community resources (as documented in the service plan). Case Manager will follow up on referrals and linkages and provide aggressive outreach if appointments or contacts are missed within two business days of the missed appointments. SoonerCare (Medicaid) reimbursable behavioral health case management services include the following:

12 (I) Gathering necessary psychological, educational, medical, and social information for the purpose of service plan development. [This includes time spent with C/A/F on the completion of the strengths based case management assessment and any other gathering of information for the purposes of development of the Case Management treatment plan/objectives. This time can be either face-to-face or non-face-to-face. The actual time spent on the completion of a Medicaid Mental Health Services Plan Development - MHSPD (moderate or low complexity) for all comprehensive services can not be billed as Case Management. If the agency is only doing a Case Management treatment plan, then the time can be billed as Case Management, or the time the Case Manager spends developing the Case Management goals/objectives on the MHSPD can be billed.]

13 (II) Face-to-face meetings with the child and/or the parent/guardian/family member for the implementation of activities delineated in the service plan. [This includes face-to-face meetings for implementation of referral, linkage and advocacy activities delineated on the service plan, and face-to-face follow-up, outreach and monitoring related to these activities. This also includes face- to-face outreach/follow-up if C/A/F misses physician/medication, counseling, rehabilitation, or other supportive service appointments as delineated on the service plan.]

14 (III) Face-to-face meetings with treatment or service providers, necessary for the implementation of activities delineated in the service plan. [This includes face-to-face linkage and advocacy as delineated in the service plan, and face-to-face follow-up, outreach and monitoring related to these activities. This also includes face-to-face contact to monitor C/A/F attendance of scheduled physician/medication, counseling, rehabilitation, or other supportive service appointments as delineated on the service plan.]

15 (IV) Supportive activities such as non face-to-face communication with the child and/or parent/guardian/family member. [This includes non face-to-face communication regarding the development of the service plan. This also includes non face-to-face communication regarding implementation of referral, linkage and advocacy activities delineated in the service plan, and non face-to-face follow-up, outreach and monitoring related to these activities. In addition, this includes non face-to-face outreach/follow-up if C/A/F misses physician/medication, counseling, rehabilitation, or other supportive service appointments as delineated on the service plan.

16 (V) Non face-to-face communication with treatment or service providers necessary for the implementation of activities delineated in the service plan. [This includes non face-to-face communication regarding implementation of referral, linkage and advocacy as delineated in the service plan, and non face-to-face follow-up, outreach and monitoring related to these activities. This also includes non face-to-face communication to monitor C/A/F attendance of scheduled physician/medication, counseling, rehabilitation, or other supportive service appointments as delineated on the service plan.]

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18 What Services Are NOT Billable or Appropriate? 1. Billing transportation time. if the client needs transportation the CM needs to link the client with transportation services like bus passes, car give aways, sooner ride, etc, but if you take the client somewhere, time spent for transporting is not billable. 2. Billing for the same service on multiple clients. for example: if a CM does an hour of research on food banks and tells 10 clients about the food banks. You can't bill an hour of research for each client. you only did an hour total of research not 10 hours of research. 3. You can't bill if you did not link the client with anything. (people do this). If a client says they don't need anything...you can't bill for that. 4. Billing CM services when you actually provided rehab. If you are teaching the client a skill like budgeting, time management, how to fill out paperwork, etc, that is rehab. 5. Over billing when the CM calls to tell/remind the client about an appointment, picking up school supplies/food/clothing etc., this does not usually take an hour and a half. Billing max allowable time is a huge red flag and is unacceptable! 6. Dual relationship issues. A lot of CM say they linked the client with resources at their church, bank, YMCA etc. this is OK but make sure the client's confidentiality is not violated and the client is not linked to the therapist. Also do not hire clients to do work for you and do not socialize with clients. Remember, anytime a CM is in a position of authority over a client (i.e. their teacher, coach, youth minister, employer, etc) there is a dual relationship and potential problems!

19 The following are activities you cannot bill for case management Watching movies with clients Playing games with clients Taking clients out to eat Taking client to read/check out books at the library Taking clients to parks, fairs or festivals Playing games on the computer with the client

20 So, What Services ARE Billable? Examples: linking with food resources linking with/for clothing linking with utility assistance linking for school supplies linking with transportation services finding a name and phone number to refer/link clients to services advocating by helping clients fill out forms for services, i.e. food stamps

21 Documentation Client or client’s family expresses a need LBHP lists ways on Treatment plan to solve need through linking and advocating Client reaction to linking and advocating

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23 Example 1 Client’s mother told CM that client has been having difficulties in school. Client has failing grades and has below average reading and math skills. CM spoke with mom about the possibility of client having learning disability. CM obtained a written consent from mother to speak with school officials about concerns. Client’s mother agreed that client’s learning abilities need to be addressed. Example 2 CM advocated on behalf of client and when speaking with client’s teacher, principle and school counselor about client’s failing grades and struggles with math and reading comprehension. School officials agreed to test client for learning disability and agreed to look at the possibility moving client to a different class to address needs. Example 3 Client stated “I just can’t get a job and we need the money”. CM spoke with client about what she has done in her job search and what jobs she would like to obtain. Assisted client with building her resume. Client was linked with local restaurants in the area that are hiring currently. Client agreed to contact at least 5 restaurants and inquire about employment before our next appointment. Example 4 Client stated “ I can’t afford the rent in my apartment anymore”. CM spoke with client about the possibility of moving to government assisted housing. Client stated he would be willing to move but doesn’t know how get into assisted living. Cm advocated on behalf of client and spoke with HUD housing. Client will be mailed a application for within the next two days. Client stated he was excited about the possibility of moving into cheaper housing but ask CM to help him with the application.

24 Example 5 Direct contact. Client received his application for HUD housing. Client stated “I just worry that I’ll make a mistake” CM assisted client as he filled out his forms and linked client postal service to mail forms. He stated the forms were difficult but he felt accomplished now that the application was completed. Example 6 Client stated “I don’t feel like my anti anxiety medication is working”. CM spoke with client about his concerns about is medication. Client reported he had not spoken to his medication provider because he didn’t feel like he knew what to say. Advocated on behalf of client and called medication’s provider and discussed client’s concerns. Provider agreed to schedule an appointment with client to adjust medications. Client stated he would attend his appointment next week and openly discuss his medication concerns with provider. Example 7 Client stated “I have an appointment with my doctor in Tulsa next week but I don’t have a way of getting there. Cm linked client to Sooner Ride and discussed the importance of calling Sooner Ride several days before the appointment. Client called Sooner Ride in session and sent up a time to be picked up. Client stated he was relieved to have transportation to his Dr’s office.

25 Common problems with CM notes The note does not clearly stated what resources you provided for the client The services and resources are described in the note but the note fails to indicate how the services will benefit the client. The resource you described is not appropriate for Case Management billing (i.e. taking clients to Wal-Mart, going to garage sales, buying items and taking them to the client, billing same note on several family members {ie accessing resources for school supplies}).

26 Common reasons for note rejections An objective was not selected A therapeutic service was not selected ( Note Case Management services can be marked as “other” and CM and be typed in or as “Not Applicable” ) A time was selected that is unacceptable. Ex. 2:00 A.M. The wrong service was selected and does not match the content of the note. Ex. the note reads as a CM note but rehab was selected as the service. There is not enough information in the note to warrant the time and/or services selected. The content of the note does not match the objective selected. The content of the note is too similar to a previous note. Some of the information could be similar from one note to the next but the majority of the information needs to be specific to the client and to that individual session.

27 Remember: Case management does not mean you do everything for clients, it is a strength- based service, per policy: “Behavioral case management is designed to promote recovery, maintain community tenure, and to assist individuals in accessing services for themselves following the case management guidelines established by ODMHSAS.” (This is referencing the Strength based case management.)

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29 The End! Go Forth and Conquer!


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