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Presents Medicaid Billing in the Schools. Stephanie Aldridge School-Based Health Services 800-372-2962, ext. 1114 stephanie.aldridge@ksba.org. Nursing and Health Aide Services Are:. Professional services relevant to the health and medical needs of the child

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presents medicaid billing in the schools
Presents

Medicaid Billing in the Schools

Stephanie Aldridge

School-Based Health Services

800-372-2962, ext. 1114

stephanie.aldridge@ksba.org

nursing and health aide services are
Nursing and Health Aide Services Are:
  • Professional services relevant to the health and medical needs of the child
  • Included in the IEP/IHP or Conference Summary
  • Typically provided face-to-face and are on a one-on-one basis
slide3
A school nursemay be the first and onlyconsistent source ofhealth services formillions of uninsured/underinsuredschool-aged children.
qualifications
Qualifications

ARNP & RN

  • Current license from the KY Board of Nursing
  • LPN
    • Current license from the KY Board of Nursing and under appropriate supervision and delegation of the ARNP or RN
  • Health Aide
    • Under the supervision of and with training by a KY licensed ARNP or RN and being monitored by the supervising nurse in provision of the delegated and supervised nursing services
approved nursing aide services
Approved Nursing/Aide Services

Assessments/Evaluations:

  • Monitoring chronic medical illness
  • Report writing for evaluation or observation
  • Treatment/Therapy:
  • Administration of medication
  • Positioning
  • Gastrostomy tube feeding
  • Glucose monitoring
          • Ileostomy and colostomy care
          • Seizure monitoring
          • Catheterization and management and care of specialized medical equipment such as colostomy bags, nasalgastric tubes, and tracheotomy tubes.
continued
Handling and positioning

Wheelchair care and monitoring

Bowel/bladder care/cleaning

Skin care and monitoring

Shunt monitoring, catheterization and postural drainage

Changing trach ties

Oxygen supplementation

Continued

Treatment/Therapy:

individual therapy
Individual Therapy
  • Is therapeutic intervention by a qualified practitioner for the purpose of reducing or eliminating the presenting problem of the student.
  • This service may include many different modalities of theory and practice.
  • It is provided face-to-face and is a one-on-one encounter between the practitioner and the student.
services not billable
Services Not Billable
  • Solely educational or academic in nature
  • Medical care not related to the IEP/IHP
  • Routine nursing services which are provided to all students by a school nurse such as treatment of minor abrasions, cuts, contusions, recording of temperature or blood pressure (if not IEP related) and evaluation or assessment of acute illness
  • Services provided to the school without charge
  • Transportation of practitioner to or from site of therapy (unless contract therapist)
slide9

YOUR SCHOOLS HEALTH SERVICE LOG

Student Name:_________________________________ DOB:_______________ Medicaid ID#:___________________________

Professional Name:_____________________________ Modifier:____________________ School:________________________

Diagnosis Code(s): 1._________________

Complete all areas of header

This is to certify that services billed to Medicaid are included in the IEP or Conference Summary and do not exceed units of services specified in the IEP.

Service Provider:_______________________________________ Title:__________________________ Date:_______________

Supervising Provider:___________________________________ Title:___________________________ Date:________________

slide10

YOUR SCHOOLS HEALTH SERVICE LOG

Student Name:_________________________________ DOB:_______________ Medicaid ID#:___________________________

Professional Name:_____________________________ Modifier:____________________ School:________________________

Diagnosis Code(s): 1._________________

Fill in the date and time

Multiple time in/out is acceptable. For example: 8-9:15

11-11:45

This is to certify that services billed to Medicaid are included in the IEP or Conference Summary and do not exceed units of services specified in the IEP.

Service Provider:_______________________________________ Title:__________________________ Date:_______________

Supervising Provider:___________________________________ Title:___________________________ Date:________________

slide11

YOUR SCHOOLS HEALTH SERVICE LOG

Student Name:_________________________________ DOB:_______________ Medicaid ID#:___________________________

Professional Name:_____________________________ Modifier:____________________ School:________________________

Diagnosis Code(s): 1._________________

Calculate number of billable minutes

This is to certify that services billed to Medicaid are included in the IEP or Conference Summary and do not exceed units of services specified in the IEP.

Service Provider:_______________________________________ Title:__________________________ Date:_______________

Supervising Provider:___________________________________ Title:___________________________ Date:________________

slide12

YOUR SCHOOLS HEALTH SERVICE LOG

Student Name:_________________________________ DOB:_______________ Medicaid ID#:___________________________

Professional Name:_____________________________ Modifier:____________________ School:________________________

Diagnosis Code(s): 1._________________

Check the appropriate procedure code

(Only one box may be checked per line)

Evaluation= evaluations, observations, testing, scoring and report writing for the covered evaluation or observation.

Individual=one-on-one direct service to the child

This is to certify that services billed to Medicaid are included in the IEP or Conference Summary and do not exceed units of services specified in the IEP.

Service Provider:_______________________________________ Title:__________________________ Date:_______________

Supervising Provider:___________________________________ Title:___________________________ Date:________________

slide13

YOUR SCHOOLS HEALTH SERVICE LOG

Student Name:_________________________________ DOB:_______________ Medicaid ID#:___________________________

Professional Name:_____________________________ Modifier:____________________ School:________________________

Diagnosis Code(s): 1._________________

Check services provided and list concerns and response to treatment

This is to certify that services billed to Medicaid are included in the IEP or Conference Summary and do not exceed units of services specified in the IEP.

Service Provider:_______________________________________ Title:__________________________ Date:_______________

Supervising Provider:___________________________________ Title:___________________________ Date:________________

slide14

YOUR SCHOOLS HEALTH SERVICE LOG

Student Name:_________________________________ DOB:_______________ Medicaid ID#:___________________________

Professional Name:_____________________________ Modifier:____________________ School:________________________

Diagnosis Code(s): 1._________________

  • Initial each entry.
  • If you are supervising an aide, the aide would initial as the provider and you would initial as the supervisor.

This is to certify that services billed to Medicaid are included in the IEP or Conference Summary and do not exceed units of services specified in the IEP.

Service Provider:_______________________________________ Title:__________________________ Date:_______________

Supervising Provider:___________________________________ Title:___________________________ Date:________________

  • If this is your log, you would sign as the Service Provider. If you are an aide, you would sign as the Service Provider and the nurse would sign off as the Supervising Provider.
    • The title may be abbreviated: LPN, RN
    • Include the date of your signing.
districts billing medicaid with ksba
Adair

Allen

Anchorage

Anderson

Ashland

Ballard

Bardstown

Barren

Bath

Bell

Berea

Boone

Boyle

Bracken

Breathitt

Breckinridge

Bullitt

Butler

Campbell

Campbellsville

Carlisle

Carter

Casey

Christian

Clark

Clinton

Cloverport

Covington

Crittenden

Cumberland

Danville

Daviess

Dayton

E. Bernstadt

Edmonson

Elliott

Eminence

Erlanger

Estill

Fayette

Fleming

Floyd

Franklin

Fulton Co.

Fulton Ind.

Garrard

Green

Hancock

Hardin

Harlan Co.

Harrison

Hart

Henderson

Henry

Hopkins

Jackson Co.

Jackson Ind.

Jefferson

Districts Billing Medicaid with KSBA
  • Jessamine
  • Kenton
  • Knott
  • Knox
  • LaRue
  • Laurel
  • Leslie
  • Lewis
  • Logan
  • Lyon
  • Madison
  • Magoffin
  • Marion
  • Marshall
  • Mason
  • Mayfield
  • McCracken
  • McLean
  • Mercer
  • Metcalfe
  • Middlesboro
  • Monroe
  • Montgomery
  • Monticello
  • Morgan
  • Muhlenberg
  • Nelson
  • Owen
  • Owensboro
  • Owsley
  • Paintsville
  • Paris
  • Pendleton
  • Pike
  • Pulaski
  • Robertson
  • Rockcastle
  • Rowan
  • Russell Ind.
  • Russellville Ind.
  • Science Hill
  • Scott
  • Shelby
  • Simpson
  • Somerset
  • Spencer
  • Todd
  • Trimble
  • Union
  • Walton Verona
  • Warren
  • Washington
  • Wayne
  • Webster
  • Whitley
  • Williamsburg
  • Wolfe
  • Woodford

Lawrence

Elizabethtown

Letcher

Lincoln

Russell Co

Fairview

Grant

Graves

McCreary

Hickman

Oldham

changes to billing medicaid in the school setting

Changes to Billing Medicaid in the School Setting

The Local Health Departments have been working in the schools, and in some instances performing services related to students with IEP’s and have been billing Medicaid if the child was Medicaid eligible.  The Department for Medicaid Services has determined that if the service is in the child’s IEP, the Local Health Department will NOT be able to bill for the service under the health department’s number any longer.  They determined that the service must be billed under the School District’s provider number as these services are special education in nature. If your school district has an arrangement for the health department to provide the nursing services, this will mean that your district will need to pick up the billing of these services.  If your district has their own nurses, nothing will change for you.  It is most important to note, that this change will only affect the billing of Nursing services listed in a child’s IEP.

New Ruling from the Department for Medicaid Services

This ruling effective 8/1/2010, regarding Medicaid billing in the schools, will affect districts who contract with the Local Health Department to carry out the Nursing Services as listed in a child’s IEP.

in most cases it is the director of special education

How do I know who is my district Medicaid coordinator?

In most cases it is the Director of Special Education

can i bill medicaid without the parent s permission to do so

Can I bill Medicaid without the parent’s permission to do so?

No. In order to access Medicaid, you will need the parent’s signed consent to release the personal identifiable information listed in the student, education record. Submitting information to Medicaid or any private insurance company without the parent’s permission violates The Family Educational Rights and Privacy Act (FERPA).

if i am billing medicaid should the service be listed on the student s iep
If I am billing Medicaid should the service be listed on the student’s IEP?

Yes, All related services should be listed on the IEP, whether billing Medicaid or not.

must the specific nursing service or medication be detailed on the iep

MUST THE SPECIFIC NURSING SERVICE OR MEDICATION BE DETAILED ON THE IEP?

No, the IEP must recommend nursing services. The actual procedure need not be detailed in order to maintain the confidentiality of the student’s treatment plan and medical records maintained by the school. You should not indicate the medication on the IEP.

The IEP should reference the IHP where the detailed procedures would be located.

are mandate health services e g height weight vision screening etc medicaid reimbursable

ARE MANDATE HEALTH SERVICES (E.G., HEIGHT, WEIGHT, VISION SCREENING, ETC.)?MEDICAID REIMBURSABLE?

Routine, mandated health care services are not reimbursed except as they apply to the special education related conditions specified on the IEP. The IEP must say “nursing services” and the rest of the guidelines are followed (e.g., monitoring height and weight for a student with an eating disorder).

where does medicaid require the student s record to be kept

Where does Medicaid require the student’s record to be kept?

Medicaid has no requirements relating to the location of student records. However, state and federal education laws (FERPA) specify the requirement for the security and access of student records.

For audit purposes, the school district should be aware of the location of all records containing documentation relating to services billed to Medicaid. It is recommended records be kept in the special education office.

what is hipaa and do i need to be concerned
What is HIPAA and do I need to be concerned?

HIPAA generally does not apply to elementary or secondary schools because the school either: (1) is not a HIPAA covered entity or (2) is a HIPAA covered entity but maintains health information only on students in records that are by definition “education records” under FERPA and, therefore, is not subject to HIPAA Privacy Rule.

slide25

May a statement such as “nursing services as needed” be written on an IEP to allow for Medicaid reimbursement?

No, this statement alone may not be used. Although such a statement is allowable by Medicaid, DOE requires that the specific services to be provided must be documented on the IEP or IHP. The service must be individualized and necessary to assist a child with a disability to benefit from special education.

I suggest a statement such as: “nursing services to include; administration of medication, transitioning, positioning and feeding assist.”