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Medicaid Billing Module Occupational Therapy Billing Form Medicaid Billing Module Occupational Therapy Billing Form

Medicaid Billing Module Occupational Therapy Billing Form - PowerPoint Presentation

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Uploaded On 2018-09-25

Medicaid Billing Module Occupational Therapy Billing Form - PPT Presentation

August 2017 Consent to Bill Medicaid Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement Consent is only good for one calendar year ID: 679075

month therapy units procedure therapy month procedure units form code minutes occupational date codes calendar medicaid billing evaluation 2015

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Slide1

Medicaid Billing Module

Occupational Therapy Billing Form

August, 2017Slide2

Consent to Bill Medicaid

Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement.

Consent is only good for one calendar year.

Parents are to be provided an annual notice.

2Slide3

Occupational Therapy Billing Form

Services must be documented on Service Care

Plan signed by the parent and therapist.

Specific ICD-10

diagnosis codes are required.

ICD-10

codes must relate to the specific type of therapy being provided. Think of these more as treatment diagnosis codes

. A global code such as Cerebral Palsy would not be sufficient.

3Slide4

Physician Authorization Form

Physician Authorization is required annually to bill for occupational therapy.

The OT listed suggested ICD-10 diagnosis codes that specifically relate to the therapy being provided.

When the physician signs the authorization form they are confirming the therapist’s code(s).

Authorizations can be signed by a Physician (MD or DO), Physician’s Assistant (PA) or by an Advanced Practice Registered Nurse (APRN).

4Slide5

Student Demographics

Use the student’s real name as listed in WVEIS

The diagnosis code is to be an

ICD-10

code that matches the need for occupational therapy.

County and school names can be written out or use the county and school WVEIS codes.

For provider name print the name of the person providing the service.

5Slide6

Procedure Codes

Complete beginning and end dates for each procedure

.

Enter the appropriate procedure code from those listed on the form. Use a separate line for each procedure code being provided during the month.

List the total number of units for the month for each procedure

. (Units cannot be rounded but can be added together within the same calendar month)

The form is to be used for only one

calendar month.

6Slide7

Procedure Code Changes

As of January 1, 2017, there is a new procedure codes for re-evaluations.

As of January 1, 2017, there are three separate procedure codes for an evaluation.

The evaluator must determine the complexity level of the evaluation choosing from low, moderate or high.

Only one of the three evaluations can be billed during the same calendar month.

7Slide8

Student Demographics

and Procedures Sample

Medicaid Number

Last Name

First Name

 

0000000000

Doe

Jane

WVEIS #

Diagnosis Code

Date of Birth

999999999

 

01-01-1900

County

1 Beginning Date

1 Ending Date

1 Procedure Code

Units

059

09/01/2015

09/30/2015

 

97110 GO

 

10

School

2 Beginning Date

2 Ending Date

2 Procedure Code

Units

 

203

09/01/2015

09/30/2015

97116 GO

5

Provider Name

3 Beginning Date

3 Ending Date

3 Procedure Code

Units

 

 

09/01/2015

09/30/2015

 

97168 GO

 

1Slide9

Explanation of Procedures

and Caps Part 1

97165

GO

Occupational Therapy

Evaluation Low Complexity

1 event per calendar year

97166

GO

Occupational Therapy

Evaluation Moderate Complexity

1 event per calendar year

97167

GO

Occupational Therapy

Evaluation High Complexity

1 event per calendar year

97168

GO

Occupational Therapy Re-evaluation

2 events per calendar year

97032 GO

Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes

20 units per month

97110 GO

Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility each 15 minutes

20 units per month

97112 GO

Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception for sitting and/or standing activities, each 15 minutes

20 units per month

97113 GO

Aquatic Therapy with therapeutic exercises, each 15 minutes

20 units per monthSlide10

Explanation of Procedures

and Caps Part 2

97116 GO

Gait training (includes stair climbing) each 15 minutes

20 units per month

97150 GO

Therapeutic procedure(s), group (2 or more individuals), each 15 minutes.

20 units per month

97140 GO

Manual therapy techniques (mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions each 15 minutes

20 units per month

97530 GO

Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance) each 15 minutes

20 units per month

97532 GO

Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) patient contact by the provider each 15 minutes

20 units per month

97533 GO

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes

20 units per monthSlide11

Start and Stop Times

Enter the start and stop times for each service on the corresponding date at the bottom of the form.

These will be used to easily identify dates billable services were conducted for students with transportation services.

If

multiple procedure codes within a session or day, each procedure code needs to have a separate start and stop time. See the OT sample form for an example of how to document on the form.Slide12

Start and Stop Times

Date

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Start

Time

 

 

 

 

 

 

 

 

 

 

 

    End Time               

Date16171819202122232425262728293031Start Time               End Time                Slide13

Certified Occupational Therapy Assistant (COTA)

COTAs can only bill for therapy

when an

Occupational Therapist (OT) certified by the WV Board of Examiners is directly supervising.

Directly supervising requires the Board Certified OT to be on site when the therapy is being provided.COTA progress/therapy logs are to be co-signed by the supervising OT for therapy dates that are billed for Medicaid. This only applies to

dates when the OT was directly supervising the COTA

. To make this clear to the person entering

billing, the OT should initial the days that they provided direct supervision.COTAs can not bill for evaluations.Slide14

Additional Documentation

Progress/therapy logs will also be required.

Original copies of progress/therapy logs must be on file in the special education central office.

There is not a required form for documentation of progress/therapy logs.Slide15

Signature and Credentials

Staff who provided or directly supervised the service will sign the form and list credentials.

For COTAs, the supervising OT must co-sign the billing form.Slide16

Terry Riley – Coordinator

Office of Special Education

tjriley@k12.wv.us

304-558-2696

ext 53223

WVDE

Medicaid Website:

http://wvde.state.wv.us/osp/medicaid.html