…or… “Everything You Ever Wanted to Know About Billing…But Were Afraid to Ask!”
A training module for FPS therapists created byCheri Johnson, MSWCentral Washington University for Children’s AdministrationOlympia, Washington
Introduction This training will focus exclusively on all FPS billing and payment procedures. • Prior to reviewing this material, it is important that the FPS therapist has already read through the Client Service Contract and completed the “Deliverables” training.
Before beginning this training…. Please have the following items handy: • Your copy of the FPS Client Service Contract • Handouts, plus a blank copy of the FPS Monthly Status Report • Highlighter • Note-taking implements (pen and paper, sticky notes)
The Monthly Status Report… • Is a CA-designated document which may not be altered or replaced with a substitution. • Is the sole means by which a contractor may submit FPS billing and reimbursement requests to Children’s Administration.
The Monthly Status Report… • Consists of two distinct parts, the narrative portion and the Financial Reconciliation Page. • Both parts should be completed at the same time and submitted to the fiduciary specialist as one document (along with any required receipts).
The Monthly Status Report… • Must be received by the fiduciary specialist for your provider and region by the 10th working day of each month… • …However, the earlier your reports are submitted, the sooner you will receive payment from CA!
Let’s take a look at the Monthly Status Report, and walk through it item by item. • Please get out your copy of the MSR, along with a pen or pencil, and a highlighter, if desired. • We’ll also be referring to the FPS Client Service Contract, so you might want to keep it handy.
Narrative Section The narrative portion of the Monthly Status Report is subdivided into three specific sections: a heading, a table, and the narrative itself.
The Heading Fill in all information accurately and completely. • The phone number requested is YOURS, not the social worker’s—this is in case the fiduciary specialist has a question regarding your report and needs to contact you.
The current service time period refers to those dates during the month in which the case was actually open. List dates of weekly contact with CA social worker (if your contact was more frequent, you only need list 4 or 5 dates, one in each calendar week).
Leave the date of termination blank until you submit the final Monthly Status Report—upon terminating services and closing the case. Do not count forward 6 months from the referral date and enter that date; it’s actually fairly unlikely the case will still be open by that time.
The Table The table on page 1 of the Monthly Status Report is fairly self-explanatory: it requests the dates on which face-to-face contacts were made with members of the family, and the length of each contact.
Even if the contact only lasted 10 minutes or was unscheduled (e.g., running into the client at the grocery store, where they proceeded to tell you some new development), include this… …in 15 minute increments, of course!
Include both therapist and parapro family contacts, to provide an accurate summary of total number of face-to-face contacts and total amount of time spent with the family. Add up the number of hours, and enter the total in the bottom row of the table.
The Narrative In this section, each goal currently being addressed in the family’s Service Plan is listed, along with descriptions of goal-related activities that have occurred during the month and progress being made (or not) on each goal.
State each goal as written in the family’s Service Plan. • Under “Progress,” describe only those case activities related to the preceding goal, and progress made (or the lack of progress, if that is the case).
Don’t forget to explain any use of Concrete Goods/Support Services funds related to each goal… • …basically, you are providing the same justification for the use of these funds as you gave the social worker when you first requested them.
Provide concise but thorough information related to goal-related activities and progress. • Indicating, “Good,” “None,” or even something like, “Moderate progress has been made on this goal” is NEVER sufficient explanation! • Provide pertinent details to support your assessment of progress made or lack thereof.
In the “Comments” section, include information that is not goal-specific (which would be listed under the appropriate goal) yet pertinent to the case, which the social worker needs to know. • NOTE: The social worker should already be aware of most of this info, courtesy of your weekly updates.
Keep in mind that CA social workers frequently submit Monthly Status Reports in court cases… …which means your reports are often read by many other individuals, who will assess your work based on these, and other, reports. • So be professional, and do your best!
Financial Reconciliation Page To fully understand FPS billing procedures, it’s perhaps most helpful to turn back to the Client Service Contract to review the pertinent definitions before we discuss them in detail.
What is Billable? According to the Payment Schedule in the FPS Client Service Contract, just about everything you do related to a case is billable… …but let’s look at some specifics.
Direct Counseling Time • This means any face-to-face contact with the family present. • Regardless of the activity (counseling, shopping, waiting in a doctor’s office with them, etc.), if the client is with you and you are interacting with them, it’s billable under direct counseling time.
What if you’re in your car with a client? Unless you’re chauffeuring them in your limo with the privacy screen closed… …it’s direct counseling time, not traveltime (but don’t forget to bill for your mileage).
Often, therapists find some of their most effective client interactions take place in their vehicle… …a serendipitous benefit when it becomes necessary to transport a client for some reason!
Case-Related Activities This category covers virtually any other billable activity performed by FPS therapists (except for travel and waiting). Defined in the Client Service Contract as: “those activities that will impact the family but do not actually require the family’s direct involvement.”
The contract lists a number of examples of such billable activities: • collateral contacts (either face-to-face or on the phone) • attendance at CPT meetings or other formalized staffings • court time • report writing and general documentation • supervision of paraprofessionals
However, there are many other common case-related activities (for example, participating in a case conference) for which you may bill. Rule of thumb: if an activity is specifically related to a case in some way that will assist the family in accomplishing the goals of their service plan, you may bill for it.
Traditionally, the category of Case-Related Activities has been divided into three specific areas: • Collateral contact • Paperwork • Other case-related activities Let’s examine these sub-categories more closely, to ensure a full understanding of each.
Collateral Contact This refers to phone calls and/or face-to-face meetings with social workers, school personnel, attorneys, probation officers, etc., made by the FPS therapist when the client is not present.
Important Note: • If a client is present during any of these activities, the activity is billed as direct counseling time. • If the client is present when the therapist is speaking with the referring social worker about the case, this may also be counted as a weekly case update, though billed and tracked as direct counseling time.
Collateral contacts include contact with the referring social worker and with anyone for whom you have a release of information, who is not anactual family member (unless it is extended family not living in the family’s home).
You will most likely have more collateral contact with the referring social worker than with anyone else (particularly since weekly contact is mandated), so be sure you are both documenting and billing for these contacts!
What about phone calls to/from client family members? A slightly different situation, phone calls to or from clients—generally, the referred family, identified on the referral form and living together in the primary residence—are considered neither direct counseling time (not face-to-face) nor collateral contacts (which category only includes non-family members).
An important word (or four) about client phone calls… • They are not billable. 2. They are not billable. 3. THEY ARE NOT BILLABLE! (really!)
Despite what you may have heard from a social worker, a colleague, or even your supervisor, the FPS Client Service Contract does not allow providers to bill for phone calls to/from members of CA-referred families. • Not even in emergency situations. • Not even when a phone call, as opposed to a face-to-face meeting, is clinically indicated.
And we’re not just talking phone calls here; communication with the client via any type of electronic device (e.g., e-mail) is non-billable… …with one important exception: if the client must use such equipment as reasonable accommodation for a disability.
So for all intents and purposes, just remember: Phone calls to or from a client are not billable!
Paperwork “If it isn’t documented, it didn’t happen!” A bit dramatic, perhaps, but the importance of completing FPS paperwork (and on time) cannot be over-emphasized!
The term “paperwork” refers to all documentation related to an FPS case: • Charting notes • Family Assessment • Monthly Status Reports • Exit Summary • Any other written reports which might be requested of you (such as court reports)
Requirements related to these specific types of documents are outlined in the “Deliverables” training, and will not be repeated here, except as related to billing.
Special notes on billing for Family Assessments • When meeting with a family and focusing on assessment, this is billed as direct counseling time. • When scoring the NCFAS/NCFAS-R in your office, or actually writing the narrative Family Assessment, this is billed as paperwork time.
Special notes on billing for Service Plans • When developing goals and objectives for the Service Plan, since all work is done together with the family, this is billed as direct counseling time. • When typing the completed plan before getting signatures and sending a copy to the social worker for approval, this may be billed as paperwork time.
Bill only a reasonable amount of time for paperwork, even if it takes you much longer to complete. For example, the first time you complete a NCFAS/NCFAS-R, it may take you an hour or more—but a reasonable suggested amount of time to bill is about 30 minutes.
Other suggested amounts of time to bill for typical documentation: • Average Charting Note (depending on provider’s required format): .25 hrs • Average Monthly Status Report: .5 hrs • Average Family Assessment (not including scoring of NCFAS/NCFAS-R: 1-3 hours, depending on format and thoroughness • Average Exit Summary: 2-3 hours
Q: Why might a provider want to bill less time than is actually spent on paperwork???? A: Because, realistically, the more hours we bill for doing required documentation, the fewer hours we have available for direct face-to-face contact with our clients.
Please Note! You may not bill for agency-required, non-client-specific paperwork, such as filling out your timesheet or agency mileage reimbursement form, developing an on-call schedule, etc. Your agency may or may not pay you for these activities—but CA will NOT compensate a provider for any activity not directly related to a specific case.