1 Minnesota Department of Human Services Medical Assistance Individualized Education Program (IEP) Services March 2007 March 2007 Minnesota Infinite Campus Interchange Minnesota Infinite Campus Interchange

2 IEP Services Technical Assistance Guide  All information about medical assistance eligible individuals and providers, billing, coverage policy, rates, settle-up  Go To: Individualized Education Program (IEP) Services Web page Under “Quick Links” Under “Quick Links” DHS #443DHS #443  Updated regularly  Must have a current copy Section K – IEP Services Technical Assistance Guide Section K – IEP Services Technical Assistance Guide

3 Other IEP Web Page Information  News and latest additions NPI InformationNPI Information  Quick links for IEP service providers Forms & documentsForms & documents IEP TA GuideIEP TA Guide Settle-up documentsSettle-up documents Family BrochuresFamily Brochures Provider enrollment informationProvider enrollment information  Billing and information resources MN-ITS informationMN-ITS information Paper claims instructionsPaper claims instructions Payment and claim cut-off calendarPayment and claim cut-off calendar Section K – IEP Services Technical Assistance Guide

4 Eligible Children  Under age 21  Enrolled in Medical Assistance or MinnesotaCare Major programs MA, RM, LL, EH Major programs MA, RM, LL, EH Eligible on dates services provided Eligible on dates services provided Verify eligibility monthly Verify eligibility monthly MN-ITS Eligibility VerificationMN-ITS Eligibility Verification Enhanced touch-tone automated phone Eligibility Verification SystemEnhanced touch-tone automated phone Eligibility Verification System  Receive covered services On dates billed On dates billed  Current IEP, IFSP, or IIIP Section C – IEP Services Technical Assistance Guide

5 Eligible Providers  Public schools and school districts  Tribal schools  Charter schools  Education districts  Intermediate districts  Service cooperatives  Special education cooperatives  State academies Section D – IEP Services Technical Assistance Guide

6 Enroll as MHCP Provider  Complete application and sign agreement Each district must enroll separately Each district must enroll separately  Consolidated/unconsolidated districts May need new MHCP provider number May need new MHCP provider number Contact Provider Enrollment Contact Provider Enrollment Section D – IEP Services Technical Assistance Guide

7 NPI Numbers  National Provider Identifier One unique number for billing all payers One unique number for billing all payers Federally assigned 10 digit number Federally assigned 10 digit number Replaces current 9 digit MHCP number Replaces current 9 digit MHCP number Required by May 23, 2007 Required by May 23, 2007  CMS Web site verview.asp verview.asp verview.asp verview.asp Or access from IEP Services Web page Or access from IEP Services Web page

8 IEP Services  Carved out of managed care Bill services directly to DHS Bill services directly to DHS  MEDICALLY NECESSARY  Included in IEP, IFSP, IIIP Example: Is it covered by MA? Example: Is it covered by MA? Cannot be a factor in decisionCannot be a factor in decision  Provided by qualified service providers  Meet all requirements for service  Documented before billed Section E – IEP Services Technical Assistance Guide

9 Covered Services  Physical Therapy  Occupational Therapy  Speech Language Hearing Therapy  Mental Health Services  Nursing Services  Personal Care Assistant Services  Assistive Technology Devices  Special Transportation  Oral Language Interpreter Services Section E – IEP Services Technical Assistance Guide

10 Billing  Qualified billers Schools and districts Schools and districts Billing agents Billing agents Fees must be related to cost of processing the billingFees must be related to cost of processing the billing Cannot be a percentage of amount billed or collectedCannot be a percentage of amount billed or collected Cannot depend on collection of paymentsCannot depend on collection of payments  Use correct provider ID numbers Section F – IEP Services Technical Assistance Guide

11 Third Party Liability  Medicaid is the payer of last resort for all other liable parties Exception: schools and districts Exception: schools and districts  Obtain payment or a denial of coverage from liable parties Exceptions: special transportation and PCA services Exceptions: special transportation and PCA services Use DHS TPL letter or submit claims Use DHS TPL letter or submit claims Cannot change the letterCannot change the letter Send copies of responses to GenieSend copies of responses to Genie

12Billing  Electronic claims Web based MN-ITS Web based MN-ITS Directions for completing claims in IEP TA Guide Directions for completing claims in IEP TA Guide  Paper claims Required for AT devices & claims with no response from private health plans Required for AT devices & claims with no response from private health plans Directions for completing claims Directions for completing claims Mail in DHS 1863 envelopes Mail in DHS 1863 envelopes  Payment & claim cut-off calendar IEP Web page IEP Web page

13 Billing Codes  Physical Therapy  Occupational Therapy  Speech/Language/ Hearing Therapy  Mental Health Services  Nursing Services  PCA/Para Services  Assistive Technology Devices  Special Transportation  Oral Language Interpreter Services  T1018 U1  T1018 U2  T1018 U3  T1018 U4  T1018 U5  T1018 U6  T1018 U7  T1018 U8  T1013

14 Billing Units  Physical Therapy  Occupational Therapy  Speech/Language/ Hearing Therapy  Mental Health Services  Nursing Services  PCA/Para Services  Assistive Technology Devices  Special Transportation  Oral Language Interpreter Services  1 per day per child  1 per complete device  1=1mile  1=15 minutes

15 Billing Units PT, OT, Nursing, PCA, Mental Health, Speech/ hearing Maximum 5 units/5 days; document all time spent AT devices 1 complete device; enter 1 under “units” Special transportation Number of miles; partial miles; round down ≤.5; round up >.5

16 Use Caution  Common billing errors All claims All claims Units and days in date span don’t matchUnits and days in date span don’t match Wrong modifierWrong modifier COB information missingCOB information missing No rateNo rate Paper claims Paper claims Missing unitsMissing units Missing attachmentsMissing attachments Missing contact informationMissing contact information Missing chargeMissing charge

17 Remittance Advice  Claims invoice Paid claims Paid claims Denied claims Denied claims Suspended claims (on supplement page) Suspended claims (on supplement page) Ignore supplemental page except suspended claimsIgnore supplemental page except suspended claims

18 Rates  Cost-based rates: Physical therapy, occupational therapy, speech language hearing therapy, and mental health, nursing, PCA services Physical therapy, occupational therapy, speech language hearing therapy, and mental health, nursing, PCA services  Formula 1. Total Salaries + Benefits ÷ Total Employment Hours 1. Total Salaries + Benefits ÷ Total Employment Hours 2. Item 1 X Direct Medical Assistance Service Hours 2. Item 1 X Direct Medical Assistance Service Hours 3. Item 2 ÷ Medical Assistance Encounters 3. Item 2 ÷ Medical Assistance Encounters 4. Item 3 X District’s Unrestricted Indirect Cost Percentage 4. Item 3 X District’s Unrestricted Indirect Cost Percentage 5. Rate = item 3 + item 4 5. Rate = item 3 + item 4 Section G – IEP Services Technical Assistance Guide

19 Rates  Special transportation One statewide rate - $2.21 per mile One statewide rate - $2.21 per mile  Oral language interpreter services $12.50 per 15 minute unit $12.50 per 15 minute unit Section G – IEP Services Technical Assistance Guide

20Payments  Current year payments - Interim rates Interim rates are based on a previous year’s costs Interim rates are based on a previous year’s costs  Federal share – 50% Schools and districts responsible for the non-federal share (50%) and administration fee (currently 4%) Schools and districts responsible for the non-federal share (50%) and administration fee (currently 4%) Excess administration fees collected returnedExcess administration fees collected returned  Remittance Advice Payment “invoice” Payment “invoice” In MN-ITS mailbox (90 days worth) In MN-ITS mailbox (90 days worth) Not organized by date – can be sorted by date Not organized by date – can be sorted by date Include finance officer as a MN-ITS user Include finance officer as a MN-ITS user Section G – IEP Services Technical Assistance Guide

21Settle-up  Reimburse actual costs PT, OT, Speech/hearing, mental health, nursing, PCA PT, OT, Speech/hearing, mental health, nursing, PCA Previously paid claims reprocessed and paid at settle-up rate Previously paid claims reprocessed and paid at settle-up rate Document actual cost data and retain for 5 years Document actual cost data and retain for 5 years  Rate calculation Uses actual cost data reported to MDE and DHS & unrestricted indirect cost percentage Uses actual cost data reported to MDE and DHS & unrestricted indirect cost percentage  Requirements Bill, receive payment, report accurate cost data Bill, receive payment, report accurate cost data OR, settle-up and new interim rates = $0.00OR, settle-up and new interim rates = $0.00

22 Record Keeping and Documentation  Keep a record that includes: Medical diagnosis or condition Medical diagnosis or condition Results of evaluations/assessments Results of evaluations/assessments Treatment Goals/Care Plan Treatment Goals/Care Plan Complete copies of current: IEP, IFSP, IIIP, Individual Health Plan, Individual Behavior Plan, Individual Treatment PlanComplete copies of current: IEP, IFSP, IIIP, Individual Health Plan, Individual Behavior Plan, Individual Treatment Plan Document actual services provided for all services Document actual services provided for all services trip logs, activity/progress logs, PCA checkliststrip logs, activity/progress logs, PCA checklists Required orders & Physician’s Statement of Need Required orders & Physician’s Statement of Need Documentation of supervision or direction Documentation of supervision or direction  Keep all documentation for 5 yrs Section H – IEP Services Technical Assistance Guide

23 Auditing and Monitoring  Written documentation required If it is not written down, it was not done!! If it is not written down, it was not done!!  State and federal audits of services billed no set schedule no set schedule complaints - 24 hours notice complaints - 24 hours notice required documents and service documentation for services billed required documents and service documentation for services billed  PERM-Payment Error Rate Measurement program Section I – IEP Services Technical Assistance Guide

24 DHS Contacts  IEP services policy and billing: Genie Potosky, Coordinator Genie Potosky, Coordinator (651) ; ; Bob Ries, Provider Trainer Bob Ries, Provider Trainer (651) ; ;  IEP services rates: Jesusa Williams Jesusa Williams (651) ; ;  Provider Call Center: (651)