Third Party Reimbursement – Covered Services Jenny Roth - DHS IEP Coordinator Health Care – Purchasing and Delivery Services (PDS) 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Minnesota Department of Human Services | mn.gov/dhs Eligible Providers To bill Medical Assistance (MA) for the federal share of IEP health related services, districts and tribal schools must enroll with Minnesota Health Care Programs (MHCP) as a health care provider. It is the responsibility of the districts to ensure the individuals performing IEP health related services are qualified, properly trained, licensed, certified and are working within their scope of practice. 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Minnesota Department of Human Services | mn.gov/dhs Eligible Children A child must meet the MHCP eligibility requirements in order for schools to be reimbursed by MA. Eligibility requirements include: The child or youth is under the age of 21 Is actively enrolled in one of the following MHCP major programs: MA - Medical Assistance NM - Non-citizen program that include CHIP eligibly types CB or PC RM - Refugee Medical Assistance for first 8 months after arriving in the United States Has a current IEP or IFSP that identifies the special education needs, supports, accommodations and the specific health related services the child will need throughout the school day because of the child’s disability 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Minnesota Department of Human Services | mn.gov/dhs Identify the Service Assistive technology devices Interpreter services Mental health Nursing Services Occupational Therapy (OT) Physical Therapy (PT) Speech Language Pathology and audiology service Personal Care Assistance Transportation 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Minnesota Department of Human Services | mn.gov/dhs Documenting 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Errors from past audits PERM or CMS audits have found the following errors: Non-covered services provided to students Documentation that does not demonstrate the need for the health related service Lack of, or inadequate documentation in progress reports Missing or Inadequate clinical notes The start and end times for services rendered were not documented Records indicate the service was provided, but the attendance records show the child was not is school that particular day 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Minnesota Department of Human Services | mn.gov/dhs Documentation Record Keeping and Documentation Health Care Service Records Additional documentation information Service Time and Encounters Record Retention 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Coding and Billing Requirements Billing and Authorization Requirements ICD Codes Seek Reimbursement from other payers Timely Billing Reporting Coordination of Benefits IEP Procedure Codes, Modifiers and Units 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Minnesota Department of Human Services | mn.gov/dhs Online Resources The IEP provider Home page will provide links to forms, checklists, logs, reports, documents and other IEP related resources, and also CTSS resources for school certification, recertification and tracking document. (http://www.dhs.state.mn.us/provider/iep) The IEP Services Manual should be used as one of your primary information resources for MHCP polices, covered services, rates and billing requirement for reimbursement. (http://www.dhs.state.mn.us/main/dhs16_151385) 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Online Resources – MHCP IEP Provider Home Page 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Online Resources – MHCP IEP Services Manual 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs
Can you tell me… Questions ? What If…
Minnesota Department of Human Services | mn.gov/dhs Thank you! Jenny Roth, Jenny.M.Roth@state.mn.us 651-431-2622 1/13/2019 Minnesota Department of Human Services | mn.gov/dhs