Contracted and Newly Hired Hearing Itinerant Professional Development ACCESS Claiming Information and Electronic Service Documentation Friday, September 18, 2015

Agenda Review the Requirements for the ACCESS Program Medical Authorization and Introduce New Compliance Screen Introduce the Service Documentation Screens Tips for Service Documentation Introduce Logging Screens Review How Claims are Submitted and the 15 minute increment Review Group vs. Individual Service Documentation Review Collateral Service Documentation Review Progress Note Documentation – Qualitative vs. Quantitative Review the Error Reports Review the EasyTrac History Screen and tracking of Medicaid Parental Consent Review the 150 day cycle – no more retroactive submissions Introduce Pending Eval/Re-evaluation Process Changes Introduce New Screens Questions and Answers

ACCESS Program Claiming Requirements The student must be identified as Chapter 14. The student must be Medicaid Eligible. The Medicaid Parental Consent form must be signed Yes and on file with the ACCESS Office. The One Time Consent form if signed Yes will cover services moving forward. Forms signed both Yes and No are treated as a No. The service provider must be registered with the ACCESS office and meet the criteria to be credentialed with an ACCESS Provider number. A current copy of the provider’s professional license must be on file with the ACCESS Office. The services must be provided by the service provider submitting the claim. Absolutely No intern services are to be claimed. There must be Medical Authorization on file to cover the dates of service. The only dates covered are those after the Medical Authorization is signed regardless of when the IEP started. A new compliance screen is being developed to track the authorization information. There must be an IEP in place recommending the service and covering the date of service to be claimable. Note: The EasySystem is a Full Electronic Documentation system and all services should be documented regardless of claiming status.

Sample Medical Authorization Tracking Screen

Tips for Recording Hearing Services Make daily entries of the services provided to assure the accuracy of the data. Be sure to be as timely as possible so that the student record is always current. Pay close attention to the type of service and the time required to perform the activity. If the student is listed for group services, they should not be receiving individual services. Separate services into correct categories. Be careful not to duplicate or overlap services. At the end of the month, review all services to assure your service entries have been recorded correctly. Maintain a caseload of students for whom you are currently part of the team. Once all services have been completed and the monthly summary recorded, a student may be removed from your caseload. Utilize the Green Checkmark/Yellow Yield Sign/Red Stop Sign to review actual IEP dates and Medicaid Parental Consent. Only use the dates that have a final document attached to them. If you are not sure how to document a particular item, contact the ACCESS team for assistance. A written report should be available for presentation to an auditor for all evaluations/re-evaluations claimed under ACCESS.

Selecting the Month Of Service

Service Specific Information

Collateral Service Documentation

Direct Service Documentation

15 minute increments Services eligible for reimbursement under the school based ACCESS program are reimbursed in 15 minute increments. Services under the 15 minute increment, round down to 0 and are not claimed. Services over 15 minutes are claimed in 15, 30, 45 or 60 minute intervals. If a service is over one interval, but under the next, i.e. 40 minutes, the service is rounded down to 30 minutes and the remaining minutes are left unclaimed.

Individual vs. Group Services are to be logged as listed in the IEP. If the IEP lists that the student is to receive 30 minutes of group therapy, then the session is to be recorded as group for the ACCESS program. A note should be made in the Description of Service/Daily Note box indicating if the session was not a group session and why. Please note that according to the team at DHS, Medicaid guidelines reflect that services that cannot be completed as listed in the IEP should be rescheduled for a later time.

Collateral Service Documentation Collateral services are not claimable under the School Based ACCESS Program. Several services that were formerly collateral services have been reclassified as direct service for the purpose of evaluation/re-evaluation. These include, but are not limited to, classroom observation, consult with medical personnel and writing the evaluation report.

  What is a Progress Note?     The written record that supplies the details of how the student utilized their treatment plan.  

Why Do We Use Progress Notes? Progress notes are vital to good clinical treatment. Charts the students’ journey through the continuum of care. Improve and enhance the treatment process by helping the direct service provider track the students’ progress in treatment while staying focused on the treatment plan. Good progress notes also assist other program staff to participate intelligently in the students’ treatment process. Review of progress notes is the best way to refresh ones memory when sitting with the IEP team to discuss the students’ progress. If the primary direct service provider is not available to provide support to the student, the chance that another direct service provider will be able to provide meaningful assistance may be dependent on the quality of documentation in the progress notes  

How? Essential that the direct service provider is able to give a complete picture of the student’s progress and/or lack of progress. Progress note should always include documentation of development with the use of suggested activities or strategies during daily routines. Notes should explain everything that happened with the student  

  WARNINGS: A series of notes that only reports the student’s attendance and indicating that they had “good participation” are clinically useless. Additionally, if notes consistently say that service provider worked on the exact same activity for service after service, it may seem like they are not individualizing services to the student’s needs

Qualitative Data vs. Quantitative Data Quantitative data is information about quantities. It is information that can be measured and written down with numbers. Goals should be measurable and therefore notes regarding services should in turn provide data that is measureable. Qualitative data is information about qualities. It is information that can't actually be measured.

Error Reports – What Do They Mean? Invalid IEP - This report notifies the service provider that the dates of service recorded are not within the date range of the IEP and are not claimable. Missing Essential Data – This report notifies the service provider that the service entry was finalized before all of the required data was recorded. No Parental Authorization – This report notifies the service provider that the parent has not given permission for claiming to be submitted. Missing Parental Authorization – This report notifies the service provider that the parental consent form has not been submitted to the ACCESS office for programming in the EasySystem to allow claiming to occur. Expired Parental Authorization – This report advises the service provider that the Medicaid Parental Consent on file has expired and does not cover the date of service for claiming. The correct version of the Medicaid Parental Consent must be submitted for the error to be corrected. No Monthly Summary – This report notifies the service provider that the monthly summary has not been entered to allow the student’s record to be completed and the claiming cycle to begin.

Easy Trac History Screen and Tracking of Medicaid Parental Consent

Overview of the Claiming Process Begin Here Services provided to students are entered by the provider into the EasySystem. This is an ongoing process and the system reflects daily entries by multiple providers at any given time. Monthly review of the potentially claimable services is done by PCG and filtered into Potential Claim File(s) or Exception/Error Report(s). All services that have not been claimed and are still potentially claimable are considered to allow error corrections from previous months to now be considered for claiming. Potential Claim Files and Report Files are posted to a secure site by PCG and Michelle Ovington is notified that they are available. The files are then downloaded by Michelle Ovington. Claim files are reviewed as received for potential errors, i.e.. duplicates & non-claimable services. Follow up is done with the service providers for questionable entries via e-mail to verify services or remove potential errors. Exception/Error Reports are sent to the service providers bimonthly for error corrections. The OSS management team is also provided a copy of the two error report files bimonthly. Upon receipt of all of the responses from the providers regarding their questionable entries, the corrected claim file, minus non-claimable services, is posted to PCG's secure site for processing. A follow-up e-mail notice is provided to PCG to advise them the file has been posted. PCG processes the file and submits the eligible claims to the Department of Public Welfare for processing. SDP receives monthly management reports from PCG indicating the gross claims submitted each month and the revenue processed. Monies are not sent directly to SDP. We must request the funds to be sent to our FAI account. This is done through an ACCESS FUNDS REQUEST FORM (PDE-352 form) which is sent to PDE for processing. There are delays with DPW's actual release of monies, therefore SDP's practice is to submit their request for funds when they are over $1,000,000 and/or quarterly. (Note: In the past we submitted our requests monthly and we were advised that we must provide time for the monies to reach PDE for release.) Once the request is approved by PDE it takes a few weeks for the funds to reach the SDP FAI account.

Pending Changes to the Evaluation and Re-evaluation Claiming The state has removed collateral services from their EasyTrac screens as they are not claimable services. SDP has been removing these service minutes from the total time before submitting an eligible claim for processing. The state screens for evaluations are separate from the daily service logging screens and capture services as a total time for the Evaluation/Re-evaluation. We are developing a screen to work toward this but that still allows for full electronic documentation of services. Only evaluations and re-evaluations that have an ongoing health related service in the IEP are claimable when they meet all other eligibility criteria. The IEP is the claiming date for the Initial Evaluation. There is discussion throughout the state to make the re-evaluation date the claiming date instead of the IEP date for re-evaluations. This date would disallow any services provided after the re- evaluation report date. All services require Medical Authorization to be claimable. This authorization is obtained by submitting pages from the IEP to a CRNP for sign-off. Physician prescriptions may also be used to cover the Medical Authorization requirement.

Pending New Evaluation/Re-evaluation Explanations Initial Evaluation/Assessment This service type is used when the student receives a full evaluation/re-evaluation and is placed in Special Education with a health related service. Note: An evaluation report that can be presented under audit must be readily available. Re-evaluation/Re-assessment This service type is used when the student has been evaluated and is found to be in need of continued special education health related services. 504 Evaluation This service type is used when the student has been evaluated and is found Non-Exceptional (not eligible for special education services) but there is an accommodation plan (504 plan) recommended to meet the needs of the student. Evaluation - No IEP Services Recommended This service type is used when the student is not in need of ongoing health related services. Evaluation Stopped (Explanation Required) This service type is used when the evaluation process cannot be completed. It is usually used when a child is retained in Early Intervention Service for an additional year, the child moves out of district before the final Special Education determination is made or for children that are deceased or have some other extenuating circumstance.

Sample Screen Areas Covered/Assessed

EasySystem Update Scheduled for 2015-2016 Preview of the New Logging Screens

Contact Information Michelle Ovington, Assistant Director, Financial Services, ACCESS E-mail: movington@philasd.org Telephone: 215-400-5476   Martina Boardley, Regional ACCESS Representative II E-mail: mboardley@philasd.org Telephone: 215-400-5480 Jenniffer Rodriguez, Special Finance/Treasury Operations Analyst E-mail: jrodriguez4@philasd.org Telephone: 215-400-5488 ACCESS OFFICE: School District of Philadelphia 440 N. Broad Street, Suite 323 Philadelphia, PA 19130  ACCESS Fax: 215-400-4582