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Minnesota Department ofMinnesota Department of Human ServicesHuman Services
Medical Assistance Individualized Medical Assistance Individualized Education Program (IEP) ServicesEducation Program (IEP) Services
March 2007March 2007 Minnesota Infinite Campus InterchangeMinnesota Infinite Campus Interchange
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IEP Services Technical Assistance IEP Services Technical Assistance GuideGuide
All information about medical assistance eligible All information about medical assistance eligible individuals and providers, billing, coverage policy, individuals and providers, billing, coverage policy, rates, settle-uprates, settle-up
Go To: Individualized Education Program (IEP) Go To: Individualized Education Program (IEP) Services Web pageServices Web page www.dhs.state.mn.us/provider/iepwww.dhs.state.mn.us/provider/iep Under “Quick Links” Under “Quick Links”
• DHS #443DHS #443 Updated regularlyUpdated regularly Must have a current copyMust have a current copy
Section K – IEP Services Technical Assistance Section K – IEP Services Technical Assistance GuideGuide
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Other IEP Web Page InformationOther IEP Web Page Information News and latest additionsNews and latest additions
• NPI InformationNPI Information Quick links for IEP service providersQuick links for IEP service providers
• Forms & documentsForms & documents• IEP TA Guide IEP TA Guide • Settle-up documents Settle-up documents • Family BrochuresFamily Brochures• Provider enrollment informationProvider enrollment information
Billing and information resourcesBilling 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 GuideSection K – IEP Services Technical Assistance Guide
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Eligible ChildrenEligible Children Under age 21Under age 21 Enrolled in Medical Assistance or MinnesotaCareEnrolled in Medical Assistance or MinnesotaCare
Major programs MA, RM, LL, EHMajor programs MA, RM, LL, EH Eligible on dates services providedEligible on dates services provided Verify eligibility monthlyVerify eligibility monthly
• MN-ITS Eligibility Verification MN-ITS Eligibility Verification • Enhanced touch-tone automated phone Eligibility Verification Enhanced touch-tone automated phone Eligibility Verification
SystemSystem
Receive covered servicesReceive covered services On dates billedOn dates billed
Current IEP, IFSP, or IIIPCurrent IEP, IFSP, or IIIPSection C – IEP Services Technical Assistance GuideSection C – IEP Services Technical Assistance Guide
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Eligible ProvidersEligible Providers
Public schools and school districtsPublic schools and school districts Tribal schoolsTribal schools Charter schoolsCharter schools Education districtsEducation districts Intermediate districtsIntermediate districts Service cooperativesService cooperatives Special education cooperativesSpecial education cooperatives State academiesState academies
Section D – IEP Services Technical Assistance GuideSection D – IEP Services Technical Assistance Guide
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Enroll as MHCP ProviderEnroll as MHCP Provider
Complete application and sign Complete application and sign agreementagreement Each district must enroll separatelyEach district must enroll separately
Consolidated/unconsolidated Consolidated/unconsolidated districtsdistricts May need new MHCP provider numberMay need new MHCP provider number Contact Provider EnrollmentContact Provider Enrollment
Section D – IEP Services Technical Assistance GuideSection D – IEP Services Technical Assistance Guide
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NPI NumbersNPI Numbers National Provider IdentifierNational Provider Identifier
One unique number for billing all payersOne unique number for billing all payers Federally assigned 10 digit numberFederally assigned 10 digit number Replaces current 9 digit MHCP numberReplaces current 9 digit MHCP number Required by May 23, 2007Required by May 23, 2007
CMS Web siteCMS Web site http://www.cms.hhs.gov/NationalProvIdentStand/01_ohttp://www.cms.hhs.gov/NationalProvIdentStand/01_o
verview.aspverview.asp Or access from IEP Services Web pageOr access from IEP Services Web page
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IEP ServicesIEP Services Carved out of managed careCarved out of managed care
Bill services directly to DHSBill services directly to DHS MEDICALLY NECESSARYMEDICALLY NECESSARY Included in IEP, IFSP, IIIPIncluded in IEP, IFSP, IIIP
Example: Is it covered by MA?Example: Is it covered by MA?• CannotCannot be a factor in decision be a factor in decision
Provided by qualified service providersProvided by qualified service providers Meet all requirements for serviceMeet all requirements for service Documented before billedDocumented before billed
Section E – IEP Services Technical Assistance GuideSection E – IEP Services Technical Assistance Guide
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Covered ServicesCovered Services
Physical TherapyPhysical Therapy Occupational Occupational
TherapyTherapy Speech Language Speech Language
Hearing TherapyHearing Therapy Mental Health Mental Health
ServicesServices Nursing ServicesNursing Services
Personal Care Assistant Personal Care Assistant ServicesServices
Assistive Technology DevicesAssistive Technology Devices Special TransportationSpecial Transportation Oral Language Interpreter Oral Language Interpreter
ServicesServicesSection E – IEP Services Technical Assistance GuideSection E – IEP Services Technical Assistance Guide
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BillingBilling
Qualified billersQualified billers Schools and districtsSchools and districts Billing agentsBilling 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 Cannot be a percentage of amount billed or
collectedcollected• Cannot depend on collection of paymentsCannot depend on collection of payments
Use correct provider ID numbersUse correct provider ID numbers
Section F – IEP Services Technical Assistance GuideSection F – IEP Services Technical Assistance Guide
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Third Party LiabilityThird Party Liability Medicaid is the payer of last resort for all Medicaid is the payer of last resort for all
other liable partiesother liable parties Exception: schools and districtsException: schools and districts
Obtain payment or a denial of coverage Obtain payment or a denial of coverage from liable partiesfrom liable parties Exceptions: special transportation and PCA Exceptions: special transportation and PCA
servicesservices Use DHS TPL letter or submit claimsUse DHS TPL letter or submit claims
• Cannot change the letterCannot change the letter• Send copies of responses to GenieSend copies of responses to Genie
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BillingBilling Electronic claimsElectronic claims
Web based MN-ITSWeb based MN-ITS Directions for completing claims in IEP TA Directions for completing claims in IEP TA
GuideGuide Paper claimsPaper claims
Required for AT devices & claims with no response Required for AT devices & claims with no response from private health plansfrom private health plans
Directions for completing claimsDirections for completing claims www.dhs.state.mn.us/provider/iepwww.dhs.state.mn.us/provider/iep
Mail in DHS 1863 envelopesMail in DHS 1863 envelopes Payment & claim cut-off calendarPayment & claim cut-off calendar
IEP Web page IEP Web page
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Billing CodesBilling Codes
Physical TherapyPhysical Therapy Occupational TherapyOccupational Therapy Speech/Language/ Speech/Language/
Hearing TherapyHearing Therapy Mental Health ServicesMental Health Services Nursing ServicesNursing Services PCA/Para ServicesPCA/Para Services Assistive Technology Assistive Technology
DevicesDevices Special TransportationSpecial Transportation Oral Language Interpreter Oral Language Interpreter
ServicesServices
T1018 U1T1018 U1 T1018 U2T1018 U2 T1018 U3T1018 U3
T1018 U4T1018 U4 T1018 U5T1018 U5 T1018 U6T1018 U6 T1018 U7T1018 U7
T1018 U8T1018 U8 T1013T1013
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Billing UnitsBilling Units Physical TherapyPhysical Therapy Occupational TherapyOccupational Therapy Speech/Language/ Speech/Language/
Hearing TherapyHearing Therapy Mental Health ServicesMental Health Services Nursing ServicesNursing Services PCA/Para ServicesPCA/Para Services Assistive Technology Assistive Technology
DevicesDevices Special TransportationSpecial Transportation Oral Language Interpreter Oral Language Interpreter
ServicesServices
1 per day per child1 per day per child 1 per day per child1 per day per child 1 per day per child1 per day per child
1 per day per child1 per day per child 1 per day per child1 per day per child 1 per day per child1 per day per child 1 per complete device1 per complete device
1=1mile1=1mile 1=15 minutes1=15 minutes
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Billing UnitsBilling UnitsPT, OT, Nursing, PT, OT, Nursing, PCA, Mental Health, PCA, Mental Health, Speech/ hearingSpeech/ hearing
Maximum 5 units/5 Maximum 5 units/5 days; document all days; document all time spenttime spent
AT devices AT devices 1 complete device; 1 complete device; enter 1 under “units”enter 1 under “units”
Special transportationSpecial transportation Number of miles; Number of miles; partial miles; round partial miles; round down ≤ .5; round up > .5 down ≤ .5; round up > .5
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Use CautionUse Caution Common billing errorsCommon billing errors
All claimsAll 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 claimsPaper claims• Missing unitsMissing units• Missing attachmentsMissing attachments• Missing contact informationMissing contact information• Missing chargeMissing charge
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Remittance AdviceRemittance Advice
Claims invoiceClaims invoice Paid claimsPaid claims Denied claimsDenied claims Suspended claims (on supplement page)Suspended claims (on supplement page)
• Ignore supplemental page except suspended Ignore supplemental page except suspended claimsclaims
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RatesRates Cost-based rates:Cost-based rates:
Physical therapy, occupational therapy, speech language Physical therapy, occupational therapy, speech language hearing therapy, and mental health, nursing, PCA serviceshearing therapy, and mental health, nursing, PCA services
FormulaFormula 1. Total Salaries + Benefits ÷ Total Employment Hours1. Total Salaries + Benefits ÷ Total Employment Hours 2. Item 1 X Direct Medical Assistance Service Hours2. Item 1 X Direct Medical Assistance Service Hours 3. Item 2 ÷ Medical Assistance Encounters3. Item 2 ÷ Medical Assistance Encounters 4. Item 3 X District’s Unrestricted Indirect Cost Percentage4. Item 3 X District’s Unrestricted Indirect Cost Percentage 5. Rate = item 3 + item 45. Rate = item 3 + item 4
Section G – IEP Services Technical Assistance Section G – IEP Services Technical Assistance GuideGuide
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RatesRates
Special transportationSpecial transportation One statewide rate - $2.21 per mileOne statewide rate - $2.21 per mile
Oral language interpreter servicesOral language interpreter services $12.50 per 15 minute unit$12.50 per 15 minute unit
Section G – IEP Services Technical Section G – IEP Services Technical Assistance GuideAssistance Guide
2020
PaymentsPayments Current year payments - Interim ratesCurrent year payments - Interim rates
Interim rates are based on a previous year’s costsInterim rates are based on a previous year’s costs
Federal share – 50%Federal share – 50% Schools and districts responsible for the non-federal Schools and districts responsible for the non-federal
share (50%) and administration fee (currently 4%)share (50%) and administration fee (currently 4%)• Excess administration fees collected returnedExcess administration fees collected returned
Remittance AdviceRemittance 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 dateNot organized by date – can be sorted by date Include finance officer as a MN-ITS userInclude finance officer as a MN-ITS user
Section G – IEP Services Technical Assistance Section G – IEP Services Technical Assistance GuideGuide
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Settle-upSettle-up Reimburse actual costsReimburse actual costs
PT, OT, Speech/hearing, mental health, PT, OT, Speech/hearing, mental health, nursing, PCAnursing, PCA
Previously paid claims reprocessed and paid at Previously paid claims reprocessed and paid at settle-up ratesettle-up rate
Document actual cost data and retain for 5 Document actual cost data and retain for 5 yearsyears
Rate calculationRate calculation Uses actual cost data reported to MDE and Uses actual cost data reported to MDE and
DHS & unrestricted indirect cost percentageDHS & unrestricted indirect cost percentage RequirementsRequirements
Bill, receive payment, report accurate cost dataBill, receive payment, report accurate cost data• OR, settle-up and new interim rates = $0.00OR, settle-up and new interim rates = $0.00
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Record Keeping and DocumentationRecord Keeping and Documentation Keep a record that includes:Keep a record that includes:
Medical diagnosis or conditionMedical diagnosis or condition Results of evaluations/assessments Results of evaluations/assessments Treatment Goals/Care PlanTreatment Goals/Care Plan
• Complete copies of current: IEP, IFSP, IIIP, Complete copies of current: IEP, IFSP, IIIP, Individual Health Plan, Individual Behavior Plan, Individual Health Plan, Individual Behavior Plan, Individual Treatment PlanIndividual Treatment Plan
Document Document actual servicesactual services provided for all services provided for all services• trip logs, activity/progress logs, PCA checkliststrip logs, activity/progress logs, PCA checklists
Required orders & Physician’s Statement of NeedRequired orders & Physician’s Statement of Need Documentation of supervision or directionDocumentation of supervision or direction
Keep Keep allall documentation for 5 yrs documentation for 5 yrsSection H – IEP Services Technical Assistance GuideSection H – IEP Services Technical Assistance Guide
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Auditing and MonitoringAuditing and Monitoring
Written documentation requiredWritten 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 billedState and federal audits of services billed no set scheduleno set schedule complaints - 24 hours noticecomplaints - 24 hours notice required documents and service documentation for required documents and service documentation for
services billedservices billed PERM-Payment Error Rate Measurement PERM-Payment Error Rate Measurement
programprogram
Section I – IEP Services Technical Assistance Section I – IEP Services Technical Assistance GuideGuide
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DHS ContactsDHS Contacts IEP services policy and billing:IEP services policy and billing:
Genie Potosky, CoordinatorGenie Potosky, Coordinator• (651) 431-2622; [email protected](651) 431-2622; [email protected]
Bob Ries, Provider TrainerBob Ries, Provider Trainer• (651) 431-2714; [email protected](651) 431-2714; [email protected]
IEP services rates: IEP services rates: Jesusa WilliamsJesusa Williams
• (651) 431-2538; (651) 431-2538; [email protected]@state.mn.us Provider Call Center: (651) 431-2700Provider Call Center: (651) 431-2700
1-800-366-54111-800-366-5411
