Early Intervention Provider and Invoicing Manual

Transcription

1 Early Intervention Provider and Invoicing Manual Revised: 1/17 Page 1

2 Welcome to Rocky Mountain Human Services (RMHS) provider network. This manual is an extension of your contract and is a resource about RMHS s continuum of services. It will also provide you with guidelines for doing business with RMHS, including policies and procedures. Throughout this manual and the contract you receive from RMHS, individuals who provide services may also be called subcontractors. These terms should be thought of as one in the same. We use the term subcontractor in the contract because RMHS is considered by Medicaid, insurance companies and EI Colorado as the provider when we are invoicing for EI services. If an individual therapist is directly invoicing Medicaid or an insurance company for the services they provide, they are considered the provider. Rocky Mountain Human Services is a 501(c) 3 nonprofit organization that serves clients in a variety of programs. In 2012, we celebrated our 20 th anniversary and changed our name from Denver Options, Inc. to Rocky Mountain Human Services to reflect the expansion of our services. Rocky Mountain Human Services serves humanity, provides opportunity and encourages a world of compassion and hope. We utilize our human services expertise to improve the health, self-sufficiency and overall quality of life for individuals who face challenges from developmental delays, cognitive and intellectual impairments, and/or social conditions. Providing resources, care coordination and direct services for individuals, families, non-profit organizations and government agencies, we do our very best to deliver unsurpassed human services every day. Rocky Mountain Human Services is committed to ensuring that everyone who enters the agency is provided with an experience that is found to be helpful, meaningful, and individualized. RMHS values the idea and principle that each individual be given the opportunity for choice, and decision making in an environment of individual power, authority, and autonomy. We believe that growth is always evolving for all individuals that come through the doors of RMHS. We operate from a person-centered philosophy for all of the people we work with, and in our Early Intervention program, we also operate from a familycentered philosophy; the child and family, providers, and service coordinators all make a team to support the development of infants and toddlers in the context of their family. The information in this manual will provide you with a better understanding of what to expect while doing business with RMHS, but it should not be relied upon for your own company s business, financial or legal advice. If you have any questions about the information contained in this manual, our staff welcomes your call. Our goal is for this manual to facilitate a better understanding of the requirements for providers and we will update it frequently as substantive changes are made to information, processes, etc. You can find the most current version of this manual the RMHS website at We welcome you to RMHS and thank you for your commitment to working together to get infants and toddlers and their families off to a great start! Jodi K. Dooling-Litfin, Ph.D., Director of Child and Family Programs Revised: 1/17 Page 2

3 Table of Contents EI Provider and Invoicing Manual 4 Becoming a Medicaid Provider 4 Obtaining an NPI Number 5 Requirements for Provider Credentialing 5 Delivery of Early Intervention Services 7 Primary Service Provider Model 7 Early Intervention Allowable Service Definition 8 Care Coordination (CCN) Definition Miscellaneous Code verses Care Coordination (CCN) 9 Minimum Provider Qualifications to Deliver Early Intervention Services 10 Required Trainings for Early Intervention Providers 10 Provider Database and Child Outcomes Summary 10 Early Intervention Colorado Provider Database Instructions for Providers 11 Individual Family Service Plan (IFSP) 14 IFSP Meeting Participation 14 Informing RMHS Service Coordinator of Start Date 15 Exiting a Child from Services 15 Change in Provider 15 Change in Insurance 15 Therapy Assistants 15 Clinical Fellows for Speech Language Pathologists (SLPs) 16 Play and Learn Library 16 Incident Reporting 16 Progress Note Requirements 18 Transdisciplinary Team Meeting and Developmental Intervention 19 Documenting Participation in an IFSP Meeting, IFSP Review (Service) and IFSP (Annual) Service 20 Progress Note Template 21 Sample Progress Note 22 Guidelines for Medical Record Documentation 23 Appointment Cancellations and No-Shows 23 Billing and Payment 23 Funding Hierarchy 23 Progress Note Submission Requirements 24 Submitting Invoicing to RMHS 25 Security and HIPAA 25 Prior Authorizations for Service Delivery 26 PAR Requests 26 PAR Amendments 26 Prior Authorization Form - template 28 Submitting Medicaid or Insurance Denials to RMHS 29 Process for EOBs, Co-Pays, Co-Insurance and Deductibles 29 Payment 29 Complaint and Grievance Procedures 30 Provider Update Form 32 Contact Information 32 Appendix A: Early Intervention Allowable Service Definitions 33 Appendix B: Counting Minutes 40 Appendix C: Misc. code Progress Note Examples 41 EI Provider Manual Update History Log 42 Revised: 1/17 Page 3

4 EI Provider and Invoicing Manual The Subcontractor shall comply with all portions of the Early Intervention Provider & Invoicing Manual, which may be amended from time to time. The Subcontractor understands that RMHS has the sole discretion to amend such manual. The Subcontractor shall comply with any amended provisions of the Early Intervention Provider & Invoicing Manual within a reasonable time after notice is given to the Subcontractor of any amendment. The Subcontractor understands the Subcontractor is responsible for reading the Early Intervention Provider & Invoicing Manual and contacting RMHS if any current provisions or amendments are unclear to the Subcontractor. Becoming a Medicaid Provider The information contained in this section applies only to Subcontractors that have opted in for RMHS to invoice Medicaid. The State of Colorado requires that providers of certain services become an approved Medicaid provider if they will seek Medicaid reimbursement. This includes allowable Early Intervention services that are funded by the Medicaid State Plan and for which RMHS or the provider is going to invoice Medicaid for payment (such as Physical Therapy, Occupational Therapy, Speech/Language services, and other therapy services). When you will be invoicing for the services you provide directly to Medicaid, you should complete the Standard Provider Application within the Provider Enrollment site (PECOS): When RMHS will be invoicing for the services you provide to Medicaid, you should complete the Rendering Provider Application found within the PECOS website: You will need the following information in order to complete the application process: Enrollment Type: Individual within a Group Provider Type: Speech Therapy, Physical Therapist, Occupational Therapist (depending on specialty) Group Name: Denver Options dba Rocky Mountain Human Services Tax ID: EI Medicaid Provider Id: EI Medicaid NPI: Provider Services Address: 9900 E Iliff Avenue, Denver, CO Provider Billing Address: Same as Above Provider Correspondence Address: Same as Above Id to use for Billing: kshepherd@rmhumanservices.org, Phone Number: Provider Taxonomy o Speech Language Pathologist: 235Z00000X o Physical Therapist: X o Occupational Therapist: 225X00000X Please visit this site if the taxonomy types do not fit your provider type: Certification/MedicareProviderSupEnroll/Downloads/TaxonomyCrosswalk.pdf Revised: 1/17 Page 4

5 If you provide services that may be covered by Medicaid but do not wish to become a Medicaid provider, it is your right to make that choice. Providers who choose not to become Medicaid providers should just not respond to referrals for children who have Medicaid funding. If a provider provides services to a child funded by Medicaid but they are not an approved Medicaid provider they will not be reimbursed for the services provided. In order to become an approved Medicaid provider, providers should apply on the website of the Colorado Department of Health Care Policy and Financing (HCPF) at: Obtaining an NPI Number Providers of health care services are required to have a National Provider Identified (NPI) number. The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for invoicing purposes. To apply for an NPI number, providers should access the following website: Requirements for Provider Credentialing RMHS abides by the state and federal regulations requiring formal credentialing of Practitioners/Providers who are licensed by the state to practice independently and without supervision. Credentialing of these provider types must be completed before seeing patients for that payer: MD DO PT OT SLP Psychiatrist Doctoral or master s level Psychologists (PhD, CP) LPC LCSW RMHS utilizes the Council for Affordable Quality Healthcare (CAQH) ProView system for credentialing purposes. CAQH ProView, previously known as CAQH Universal Provider Datasource, is an online, safe and secure, nationally recognized database which allows providers to enter their information, upload Revised: 1/17 Page 5

6 and store necessary documentation, update as needed, and authorize payers to access their information at no cost to the provider. Each provider who requires credentialing, within a contracted group or as an individual, must have an active and up-to-date CAQH profile. Providers credentialing data needs to include RMHS in the Work History section, using the agencies or individual s contract effective date as the start date with RMHS: Rocky Mountain Human Services 9900 E Iliff Ave, Denver CO fax Office Manager and Credentialing Contact: Sharry DiQuinzio, , sdiquinzio@rmhumanservices.org Start Date: XXXXXX (contract start date)- To Present If you do not have a current CAQH account, you need to register as soon as possible so as not to delay your ability to receive referrals through RMHS. New users may self-register through the CAQH ProView Provider portal: Providers need to complete the CAQH application and the Colorado Supplements that are required. Upload a copy of any board certifications you have, and a copy of your masters/doctoral degree if you have it. Upload a copy of your personal liability insurance face sheet showing amounts per occurrence and aggregate. If you are a provider whose liability insurance is under a group policy, your name must appear on the policy face sheet, or a letter, or roster indicating which providers are covered under group policy # needs to be attached so it that it becomes one document - CAQH allows only one document to be loaded for insurance purposes so they must be together. List at least the most recent five years of work history; include specifics for Month/Year and ending Month/Year. If there is a gap of 6 months or greater - including leaves of absence, maternity leaves, active duty, illness or relocation, an explanation must be provided. In July of 2016 CAQH will be instituting revisions to the database which will require this information and won t allow you to continue without it. CAQH is designed to present questions tailored to specialties, provider types, and practice locations; however there are questions that are not applicable to all providers, such as Call Coverage, Faculty Positions; Continuing Medical Education, and Hospital Affiliations; if you believe a section of the application is not applicable to your provider type indicate N/A. If you have already created your CAQH ProView account, please be sure your information and all necessary expiring documentation such as liability insurance is current. CAQH requires re-attestation on a continuous quarterly basis, and will reminders to providers to do so. CAQH also requires reattestation after making any edits or adding information/documents; if you don t re-attest any changes will not appear to the requesting agency. CAQH is set up so the provider controls which organizations may receive their profile information. RMHS advises providers to authorize any organization that request to add you to their roster by pre- Revised: 1/17 Page 6

7 selecting ALL. Providers will receive an from CAQH notifying that XXXX plan has added them to their roster, or is requesting to do so. A variety of resources to help providers and their practice managers use CAQH ProView are available at and include short how-to videos and a Quick Reference Guide. The CAQH Help Desk ( ) is available Monday-Friday 7-7 Eastern Time, or you can providerhelp@proview.caqh.org. If you are not sure if your specific provider type requires credentialing, or have any questions regarding credentialing, please contact the RMHS Credentialing Department at sdiquinzio@rmhumanservices.org or Delivery of Early Intervention Services By becoming an Early Intervention Provider with RMHS, you are agreeing to promote the Primary Service Provider Model. The designation of a primary service provider maintains the integrity of the team interaction while minimizing the number of professionals that families and child-care providers are required to interact with on a regular basis. A primary service provider model uses a trans-disciplinary process but details the role of this primary service provider team member. Primary Service Provider Model The Primary Service Provider Model is a trans-disciplinary home-based service delivery approach. One provider of the program acts as the primary service provider to the parents or other care-givers and is selected based on expertise in child development, family support, and coaching. The primary service provider has awareness of and access to other providers with a variety of knowledge, skills and experiences. The primary service provider is seen as a coach and reciprocal coaching and learning occur between the primary service provider and care-givers and between the primary service provider and other providers. The primary service provider receives coaching from other providers through ongoing interactions and promotes a parent s or other care-giver s ability to support a child s participation in everyday experiences and interactions with family members and peers across settings. Joint visits should occur at the same place and time whenever possible with/by other providers to support the primary service provider as often as deemed appropriate by the PSP. When visits occur at separate times, the primary service provider and other program staff must inform the care providers that the purpose of the visit is to gain information that will be shared with the primary service provider for his/her continued work with the family. Ongoing interaction provides opportunities for reflection and information sharing. Other providers providing coaching to the primary service provider may vary depending on the need or desire for timely ideas and feedback. It is critical for providers to promote the Primary Service Provider Model with families. All providers will have the opportunity to be on a member of a trans-disciplinary team where they are able to use their expertise to jointly evaluate, assess and plan to best meet the needs of the child and the family in a cohesive way. Teaming through regularly scheduled meetings offers a formal time for provider-toprovider information sharing and support in order to develop strategies designed to build the capacity of parents and other caregivers to meet child and family outcomes. Revised: 1/17 Page 7

8 Rocky Mountain Human Services offers monthly meetings for many different trans-disciplinary teams to meet and lend their expertise to give strategies to best meet the needs of the child and family. These teams meet at various times and locations in Denver County. We can assist you in joining a transdisciplinary team. Please contact: Llan Barkley at lbarkley@rmhumanservices.org. Early Intervention Allowable Service Definitions Please see Appendix A for a listing of allowable Early Intervention Services. RMHS cannot pay for services that are not on the list. Care Coordination (CCN) Definition 1). Ongoing assessment and treatment time that doesn t meet CPT code definitions 2). Parent education Family training, education and support provided to assist a parent or other caregivers in understanding the special needs of the child related to enhancing the skill development of the child. 3). Teaming time outside of scheduled team meetings Consultation to adapt an environment and activities to promote development and participation in everyday routines, activities and places 4). Making of session supports, such as PECS, visual schedules, etc. Adaptation of learning environments, activities and materials to enhance developmental and learning opportunities which promote the infant s or toddler s acquisition of skills in all developmental areas 5). Care Coordination is associated with a date of service: In the event that teaming or session supports are utilized the documentation of such activities will correspond with the date of service the information was shared with the family. Care Coordination has been added as a billable service for all Early Intervention Providers. Care Coordination is intended to cover the time and cost of additional activities a provider participates in that are not billable to public or commercial insurance but are part of early intervention. Providers who have opted-out of RMHS billing will be reimbursed for the Care Coordination fee when those activities are documented. Be aware that for those opted out providers who are billing RMHS for any reason will not receive Care Coordination reimbursement for those unique clients. Providers who have opted-in for RMHS billing should still document those activities, but reimbursement is included in their contracted rate, which was developed in part with the assumption that care coordination would be provided. Care Coordination activities are to be documented in progress notes and coded as CCN ; Care Coordination is a per session code so the number of units documented is N/A. Revised: 1/17 Page 8

9 OOOOO Miscellaneous Code versus Care Coordination (CCN) When providers should use miscellaneous code: when billing for additional services that are performed without a CPT service that lasts for the entire session duration. These are services that providers can be reimbursed for from Early Intervention. When providers should use CCN : when billing for additional services that are performed or utilized with a CPT service that is either outside the session or is unrelated to the provider discipline and therefore, not billable activities. These are services that providers can be reimbursed for from Early Intervention. For example, the following table outlines examples of when to use or CCN and how to document : Care Coordination (CCN) Parent education is provided in the family s home while child is asleep for the entire session duration. Assisting a family with obtaining a library card and buying books for the child for the entire session duration. Parent education is provided that is unrelated to the provider discipline so it is not covered under any CPT code. Child is present during service delivery. Creating handout aids before meeting with the family. Assisting the family locate alternative housing for the entire session duration. Participating in an IFSP meeting when the assigned provider is not delivering direct services to the child and a CPT code cannot be utilized. How to document on progress notes Providers should include the following elements are present on each progress note when billing : - the EI Allowable Service as the CPT code - n/a as the unit amount - include No CPT code associated with service in the narrative section. - Duration of session Spending the last 10 minutes of a session coaching the family on behavioral strategies that are outside the provider s discipline. n/a How to document CCN on progress notes Providers should include the following elements are present on each progress note when billing CCN: - the EI Allowable Service - CCN as the CPT code - n/a as the unit amount Please see Appendix C for examples of how to document the miscellaneous code. Revised: 1/17 Page 9

10 Minimum Provider Qualifications to Deliver Early Intervention Services Providers are responsible for ensuring they have the appropriate qualifications and licensure to provide Early Intervention Services. If a service requires licensure, the provider must have a valid license and provide a copy of that license to RMHS. The provider is responsible for notifying RMHS within five (5) business days if their license is revoked or suspended, or they have had a malpractice claim filed against them. The link below outlines the qualifications required to provide various allowable EI services. 1). Provider qualifications linkhttp:// then click on PDF titled- Qualified Personal Standards July 2015 Required Trainings for Early Intervention Providers All Providers are required to complete the Child Outcomes Summary for Infants and Toddlers within 90 days of signing their contract. Provider Database and Child Outcomes Summary All Early Intervention providers are required to complete the Child Outcomes Summary (COS) for children on their caseload at required intervals. All COS need to be entered into the EI State Provider Database. Please see EI Provider Database instructions for Providers. 1. The COS is completed within 16 weeks of a child s entry into early intervention. 2. The COS is completed when the child exits early intervention (e.g., child turns three, child has met goals early, family moves out of state, parent choice). The Service Provider will at all times maintain complete and accurate information on the State Provider Database. Revised: 1/17 Page 10

11 Early Intervention Colorado Provider Database Instructions for Providers Please login to the EI Colorado Provider Database as soon as possible at Click on "Early Intervention Providers and Staff", and then click on the link to the Provider Database on the right hand side of the screen. All contracted providers and employees must be entered in the database prior to providing EI Services and profiles must be updated annually. Requirements: All Early Intervention (EI) providers and Community Centered Board users must complete and maintain a current record in the Provider Profile section including Details, Service Areas, and Associated CCBs. Included: 1. Existing and New Provider Login 2. How to set up your Provider Profile and apply to a Community Centered Board 3. How to apply to more than one Community Centered Board 4. How to update your information in the Associated CCBs tab in your Provider Profile 5. Website: 6. EI website home page, click on: Early Intervention Providers and Staff 7. Professionals page/highlights section, click on: Provider Database 8. 3 Options; Staff Login, Provider Login, and Create an account. Existing Provider 1. Providers with an established record will use the Provider Login with your current username and password. If you have difficulty, please contact the Provider database administrator listed on the EI Colorado website under Contact Us. New Provider 1. Choose Create an account. This is where you will create your username and password in order to sign into the Provider Login. 2. Once you ve created your username and password, log in using the Provider Login on the right side of the screen. If you have difficulty, please contact the Provider database administrator listed on the EI Colorado website under Contact Us. Upon a successful login, you will be on your home page. You will see the following options in the green bar at the top; Home, Children, and My Profile. Home: This page will let you know if there are comments/announcements that need to be addressed and whether you have contracts, licenses, or insurances expiring within 30 days. Children: This page will be used by the CCB to assign specific children to your caseload. You will utilize this screen to enter Entry and Exit Child Outcomes Summary (COS) information. My Profile: This page contains three tabs that should be completed from left to right: Details, Service Areas, and Associated CCBs. Revised: 1/17 Page 11

12 Details: This page contains personal, professional, and demographic information. All sections under the Detail tab with the exception of Unavailable Dates and Messages, Languages, and Comments, are required. The Unavailable Dates and Messages section is used to alert others that you are absent for a specific period of time such as vacation, medical leave, etc. Languages should be completed if you are fluent in a language other than English. The Comments section is where you can personalize your profile, including adding information about special skills or interests. Service Areas: This tab provides specific area information by Counties, Cities, and Zip Code. The area(s) you choose, will affect your CCB choices during the application phase. For instance, Rocky Mountain Human Services works within Denver County. If you choose Denver under Counties, all Denver zip codes will be revealed. You can pick and choose which zip codes you would like to work in or you can choose to Add All Areas and the entire zip code list for Denver would move from the left side of the screen to the right side. This indicates that you are willing to provide services in all of the zip codes associated with Denver County. If you change your mind and you would like to remove a zip code, you can do so by choosing the red button, Remove Area. Once this is completed, you will click on the Associated CCBs tab. Please read the entire application instruction in this section before proceeding. Completing the application process in the wrong order will result in a failed submission. Associated CCBs: First (original) Application to CCB 1. Click on the green tab on the right side of the page +Click here to select CCBs in the Service Areas you ve specified 2. Click on the Select drop down menu. This will give you a choice of CCB(s) according to the Service Areas you have selected. Click on the appropriate CCB (please choose only one if more than one is listed). See Applying to an additional CCB if applying to more than one. 3. You should now see the CCB listed with an application submission status of Not Submitted. Click on the CCB and complete the associated tabs; Credentials, Licenses and Certifications, Insurance, and Trainings. These tabs must be complete in order for the CCB to verify and approve your application. If you wish to download additional informational documents, please do so in the Documents tab. 4. Once the tabs have been completed, click on the Apply to CCB button. This will alert the CCB that you have applied and change the submission status to Submitted. Once the CCB has verified your information they will change the submission status. If you are accepted as a provider, your status will read as Active. You must be active with the CCB prior to providing services. Revised: 1/17 Page 12

13 New or Existing Provider Applying to an additional CCB: If you wish to expand to additional CCBs, please follow these steps: 1. Click on My Profile. 2. Click on Service Areas and choose the areas you wish to add. 3. Click on Associated CCBs and again on the green tab on the right side of the page, +Click here to select CCBs in the Service Areas you ve specified. 4. Click on the Select drop down menu. This will give you a choice of CCB(s) according to the new Service Areas you have selected. Click on the appropriate CCB (again choose only one). 5. The new CCB will now show up in your list of Associated CCBs with a submission status of Not Submitted. 6. Click on the original CCB and make sure all of the information contained within the tabs (Credential, Licenses, etc.) is up to date. As you check the information in each tab, you will see an option to Copy this. When you click on the copy button, it will prompt you to choose a CCB. Choose the new CCB. It is very important that the new CCB has been selected and in your list prior to completing this step. Continue to copy each tab as warranted. 7. Once you have copied the required information for each tab, click on the Assoc. CCBs tab to return to the list of CCBs. 8. Click on the new CCB to ensure that each of the tabs contain the copied records. Once confirmed, click on the Assoc. CCBs tab again and return to the list. 9. Click on the Apply to CCB button. This will alert the new CCB and change the submission status to Submitted. Once the CCB has verified your information they will change the submission status. If you are accepted as a provider, your status will read as Active. You must be active with the CCB prior to providing services. Updating your Existing Associated CCB tabs (expirations, new trainings, etc.) When updating and/or adding additional information such as licenses, insurance, etc., you will do so in My Profile, Associated CCBs. If you are active with more than 1 CCB, please update the tabs under the original CCB first. Changes made to one CCB record will not automatically be reflected in additional CCB records. Once you update and save your change(s) to the original CCB tabs, you can use the Copy this feature to copy the information to another CCB. If you experience any difficulties, please contact Connie Fixsen at or connie.fixsen@state.co.us. Individual Family Service Plan The Individual Family Service Plan (IFSP) documents the treatment plan for the child and family. The IFSP outlines the types of services needed by the child as well as the frequency, scope and duration of those services. Services should be provided in accordance with the IFSP. Providers need to be cognizant of amount of services authorized for each child they serve; providers who are not invoicing through RMHS should track their utilization of units authorized in the IFSP. Revised: 1/17 Page 13

14 If the provider believes that additional units of service or a different service is needed that is not listed on the IFSP, the following process shall be followed: 1. When appropriate, the provider shall discuss the area of concern with their transdisciplinary team and obtain recommendations and strategies from their team to support the child and family 2. The provider shall notify the RMHS Service Coordinator of the new developmental concern that is outside of provider s area of expertise. 3. The provider shall implement strategies provided by transdisciplinary team member(s) 4. The provider shall notify the RMHS Service Coordinator if there is a need for a provider of another discipline to attend an upcoming visit with provider in order to gather information on the child s current skill level and provide targeted strategies to both provider and the family. Do not state to the family that a child requires an additional service or discipline. 5. The RMHS Service Coordinator will talk with the family about their concerns and discuss when they feel it would be appropriate to have another therapist meet their child. 6. If the family would like to make changes to the IFSP the RMHS Service Coordinator will notify the provider and a determination will be made if a provider from the primary provider s team is available to meet the child and determine if there is a need to change the services provided. If the team cannot provide this visit the RMHS Service Coordinator will locate a provider. 7. IFSP Review will be held with the family, current provider and possibly the provider of the new area of concern to add a visit (or multiple if determined necessary) in the area of concern and obtain the parent/guardians consent. The provider should not provide additional services until the IFSP has been reviewed; doing so would put the provider at risk of non-payment of the services provided prior the review of the plan. IFSP Meeting Participation Providers are expected to attend and participate in all IFSP meetings for children receiving services. If, for any reason, a provider is unable to attend in person the provider may attend via phone, web conference or submit a written report to the RMHS Service Coordinator prior to the IFSP meeting. Annual IFSP meetings require face-to-face participation. Providers are responsible for providing age equivalences during Annual IFSPs in all areas of development (Adaptive, Cognitive, Communication, Physical and Social & Emotional) regardless of provider s discipline. Informing RMHS Service Coordinator of Start Date When starting with a new family, providers are required to inform service coordinators within 24 hours of their initial visit or start date. Revised: 1/17 Page 14

15 Exiting a Child from Services When a child is making gains in their development and the provider suspects that ongoing intervention may no longer be needed for the child to continue to make progress, the provider shall notify the RMHS Service Coordinator. The RMHS Service Coordinator will contact the family to discuss the child s progress and how the family feels about exiting services (with a single discipline or from EI entirely). The family may request an IFSP meeting to update the IFSP and graduate the child from service(s). If the child is exiting from Early Intervention services, the provider shall complete the exit COS. Change in Provider If the current provider is no longer able to work with the family, the provider shall inform the RMHS Service Coordinator, providing as much warning as possible, to allow the RMHS Service Coordinator to locate a new provider to minimize the impact on the family. Change in Insurance Providers will notify RMHS if they become aware of family insurance changes. Please notify the RMHS Service Coordinator as soon as possible so that RMHS has ample time to collect new insurance information for billing purposes. Therapy Assistants RMHS may utilize therapy assistants in order to deliver IFSP services when there is a shortage of licensed professionals within a specific discipline. RMHS may utilize Physical Therapy Assistants, Certified Occupational Therapy Assistants, Speech Language Pathology Assistants, Paraprofessionals providing Behavioral Intervention and BCBAs. All assistants must be employees of sub-contracted agencies and may not be independent sub-contractors with RMHS. It is the responsibility of the sub-contractor to inform families of their professional status prior to initiating services. Therapy Assistants are reimbursed at a lower rate. When submitting billing, please include the word Therapy Assistant next to the provider name on each progress note. This will notify RMHS to reimburse providers at the appropriate rate. Also, a signature of the supervising staff member and date of supervision must be included on each progress note. The following requirements are in the Early Intervention Colorado State Plan (Rule 12CCR , 7.951). Use of paraprofessional if the following occurs: a. Ongoing supervision is provided by a qualified professional to assure that the paraprofessional understand the intervention plan and all procedures to be followed; and b. When a paraprofessional is providing early intervention services: 1) The Individualized Family Service Plan strategies are developed by a qualified professional; and 2) The qualified professional trains the paraprofessional to implement the plan; and Revised: 1/17 Page 15

16 3) The qualified professional providers supervision through ongoing and periodic discussions and face to face or videotaped observations at least monthly and in accordance with the guideline of the affiliated professional organization, if appropriate; and 4) All supervision of Developmental Intervention Assistants must complete the Department approved Developmental Intervention Supervisor Academy prior to assignment of supervisory responsibilities Clinical Fellows for Speech Language Pathologists (SLPs) As of January 1, 2017, RMHS will start enforcing the following policy regarding the use of speech therapy clinical fellows. Contracted EI sub-contractors shall be allowed to utilize clinical fellows to serve RMHS clients. In accordance with Colorado Medicaid guidelines, billing will be submitted by the SLP Supervising provider of the clinical fellow. Progress notes should contain the signatures of both the supervising SLP and the Clinical Fellow for all billable services, regardless of the child s funding source. Sub-contractors utilizing clinical fellows will be expected to comply with the Division of Professions and Occupations Office of Speech Language Pathology Certification requirements, which can be found at: Play and Learn Library (PAL) The Rocky Mountain Human Services (RMHS) Play & Learn Library offers therapists and families a variety of innovative toys to help children learn and grow. A provider who is contracted with RMHS can make loans from the Play & Learn Library when they are working with any children birth through six enrolled in the Early Intervention, CES and Family Support Services Program. Providers are responsible for checking out and returning items that are loaned, informing families of the purpose and correct use of the item and agree to return the item clean and in the same condition as when it was loaned out. Incident Reporting Our early intervention providers work very hard to build solid and trusting relationships with the families of children for whom they are providing therapy. It is often very difficult when a therapist, either directly or indirectly, becomes aware of the possible abuse or neglect of a child. (Abuse may be emotional, physical, sexual, or institutional). All of our RMHS contracted providers are mandated reporters and therefore have the responsibility to keep all children safe and to prevent harm. A report must be made when a reporter, in his or her official capacity, suspects or has reasons to believe that a child has been abused or neglected. Another standard frequently used is in situations in which the reporter has knowledge of, or observes a child being subjected to, conditions that would reasonably result in harm to the child. Providers should peruse the State of Colorado s website which has information about mandated reporters, definitions of abuse and neglect, and phone numbers to report abuse and neglect. The website is: Revised: 1/17 Page 16

17 As a mandated reporter, if you become aware of a situation where a child s physical and or emotional well-being is at risk you are required to call the following phone numbers for reporting abuse and neglect: CO-4-Kids or to report all concerns for a child's safety and well-being. Remember... If a child is in imminent danger, please contact the local police immediately. Suspicion of abuse is all that is necessary to report. Reports are confidential. Know where the child lives. You will be asked to describe your concerns about the child and it will be helpful if you can provide the child's name, age, address, gender, school attended (if possible), and names of parents. Please contact the service coordinator immediately after you report the suspected abuse/neglect to the proper authorities to inform him/her of the situation. If the service coordinator is not available, please contact his/her supervisor, or another member of the management team in the Child and Family Programs Department. If Rocky Mountain Human Services (RMHS) becomes aware of an allegation of abuse/neglect involving a child in our program and it is discovered that one of our contracted providers has knowledge of, but fails to make a report, that provider may be subject to a full investigation and the following may occur: 1. At a minimum, a hold may be placed on any new referrals to the provider. 2. Current services being provided by the therapist may be suspended. The arrangement for coverage of those services to customers will be made by the Child and Family Programs Department. 3. Termination of his/her contract with RMHS. Immunity from liability person s reporting (Taken from the Colorado Code State Statute ) Any person, other than the perpetrator, complicitor, coconspirator, or accessory, participating in good faith in the making of a report, in the facilitation of the investigation of such report, or in a judicial proceeding held pursuant to this title, the taking of photographs or X-rays, or the placing in temporary custody of a child pursuant to section or otherwise performing his duties or acting pursuant to this part 3 shall be immune from liability, civil or criminal, or termination of employment that otherwise might result by reason of such acts of participation, unless a court of competent jurisdiction determines that such person s behavior was willful, wanton, and malicious. For the purpose of any proceedings, civil or criminal, the good faith of any such person reporting child abuse, any such person taking photographs or X- rays, and any such person who has legal authority to place a child in protective custody shall be presumed. Revised: 1/17 Page 17

18 Progress Note Requirements Progress notes are required on all children enrolled in Rocky Mountain Human Services Early Intervention Program, regardless of funding source or invoicing method. This includes progress notes for services paid by Medicaid, Private Insurance, or the State General Fund. All documents must be submitted in a timely manner and be of high quality, i.e. they must include complete, accurate and legible information. Any of the requirements listed below need to be written in English language, no other languages will be accepted. Industry standards and best practice is that progress notes should be completed within 48 hours of service provision. Providers may use the progress note template on the following page and on the website at or they may use their own program note style, as long as it contains the below information. Click here for the RMHS progress note template. Please note: if you are using RMHS s template, please convert each note to a PDF before sending to invoices@rmhumanservices.org to limit delays in payment. If a provider is using their own progress note template, the progress note must include: The Provider s Agency Name The first and last name of the individual provider performing the service, written in a legible format (i.e. in addition to signature). The full legal name of the child as written on the IFSP, The child s date of birth; The name of the RMHS Service Coordinator for the child. The IFSP service that was provided. If billing other than a therapy service, please specify the type of IFSP by indicating whether it was an IFSP Review or an Initial Assessment. See example on page 16 for an example of how to bill for these types of services. A check mark or description of who is responsible for billing each service type (RMHS to bill or Provider to bill). See example on page 20. The diagnosis of the child. A diagnosis is required if a provider is invoicing for a service that has a CPT code. The funding for the service (e.g., Medicaid, Denver Health Medicaid Choice, Kaiser, etc.) All dates of service. The word Therapy Assistant next to the provider name, when applicable. A supervisor signature for any billing documentation submitted for Therapy Assistants or Clinical Fellows. The CPT code, if applicable, for a particular service. Some Early Intervention services, such as Developmental Intervention and Care Coordination, do not have CPT codes and therefore the provider does not have to include a CPT code for these types of services. See pages for Revised: 1/17 Page 18

19 examples of how to list these types of services on your progress notes (i.e. CCN = Care Coordination). Providers are responsible for knowing what services require a CPT code. If the service you have provided is invoiced under a CPT code, an ICD-10 diagnosis code is required on the progress note or the note is considered incomplete. The duration of the service should be entered in minutes per CPT code. If there is no CPT code for the service, then enter duration but leave the units field blank. Please see Appendix B for more specific information about counting minutes for timed codes. The total number of units per CPT code. A narrative including any progress towards the stated goals on the IFSP, the start and end time of that activity, as well as current techniques and activities used to help the child achieve their goals. Each progress note must be signed and dated. For providers on Trans-disciplinary teams who invoice for DI-Teaming during a team meeting, a separate progress note documenting the activity must be submitted for each child discussed each month that includes the child s full-name and the amount of time the child was discussed. Additionally, a separate attendance note is required for the amount of time spent at the meeting overall. See below for additional information. Providers should note on progress notes whether interpretation was used and include the name of the agency, the name of the individual provider that interpreted for the meeting, and the type of service (i.e. OT, PT, ST, etc.). Progress notes should include any no-shows. After a no-show, the provider should notify the Service Coordinator before going out to the home for a second visit. Provider should also notify the service coordinator within 48 hours for each no show. Separate progress notes must be completed for each child. Progress notes must be typed or legibly printed with only one (1) child per progress note. Progress notes that are illegible will be returned to the provider for re-submission, which may delay payment. All progress notes must be sent electronically to invoices@rmhumanservices.org in an encrypted/hipaa complaint manner. Please see later in the manual for specific instructions on deadlines for submission. Transdisciplinary Team Meeting and DI-Teaming Billing for Transdisciplinary Team Meeting and DI Teaming requires less narrative than a therapy session. If you attended a Transdisciplinary team and did not discuss a specific child on your caseload, then you will only submit a Transdisciplinary Team Meeting note with the following information: date of meeting, duration of meeting (up to 2 hour maximum), provider agency, and provider name. Indicate Trans Teaming as the non-cpt Code. If you attended a Transdisciplinary team and discussed a specific child on your caseload, then you will submit short narrative about discussion and strategies. This narrative is a separate note from the Transdisciplinary Team Meeting note, and should include the following: a short narrative documenting the discussion, child s legal name, child s Date of Birth, date of meeting, provider agency name, provider name, unit(s) - minimum of 1 unit, and provider signature and date. Indicate DI-Teaming as the non-cpt Code. Revised: 1/17 Page 19

20 Documenting Participation in an IFSP Meeting, IFSP Review (Service) and IFSP (Annual) Service Participating in an IFSP Meeting: To be utilized when a provider attends an IFSP review or annual meeting for a child when they are also the service provider listed on the IFSP and services will continue after completion of the current IFSP. The provider will bill this as the IFSP service (using the same IFSP allowable services as weekly billing sessions) and the funding source is determined by the provider based on their clinical expertise and amount of billable services provided during the IFSP meeting. IFSP Review (Service): To be utilized when a service has been completed and the assessment does not result in a new EI service on the child s IFSP. This service can be utilized when a provider participates in an IFSP Periodic Review and the service the provider is addressing is not documented in the current IFSP that is being created and the provider will not continue to see the client. IFSP Annual (Service): Used for situations when additional developmental expertise is required to determine current levels of development in all domains at the annual IFSP meeting. This service can be utilized when a provider participates in an Annual IFSP meeting and the service the provider is addressing is not documented in the current IFSP that is being created and the provider will not continue to see the client. Revised: 1/17 Page 20

21 Early Intervention Program Progress Note CLIENT NAME: DOB: Click here to enter a date. ICD10: SERVICE COORDINATOR: PROVIDER NAME: IFSP SERVICE FREQUENCY: EI SERVICE: Choose an item. PROVIDER AGENCY: SERVICE LOCATION: DATE OF SERVICE:Click here to enter a date. START TIME: END TIME: FUNDING SOURCE: Medicaid State General Trust Fund Commercial insurance Key for services with no CPT code: NS=No show CCN=Care Coordination 00000=Misc Code #of units Click here to enter text. CPT Code Click here to enter text. Outcomes/Session Plan RMHS to bill or Provider to bill Choose an item. Total Session Duration (mins.) Click here to enter text. Observations/Progress toward IFSP Goal(s): Recommendations/Strategies: Provider Signature /Date: Supervising Staff Signature/Date (if applicable): **ATTN: Please convert this document to a PDF format before submitting securely to invoices@rmhumanservices.org Revised: 1/17 Page 21

22 Early Intervention Program Progress Note (sample) Sample Progress Note CLIENT NAME: John Smith DOB: 4/14/2014 ICD10: R62.0 SERVICE COORDINATOR: Bob Smith EI SERVICE: Physical Therapy Services PROVIDER NAME: John Doe, Therapy Assistant PROVIDER AGENCY: PT ABC, Inc. IFSP SERVICE FREQUENCY: Weekly SERVICE LOCATION: In Home DATE OF SERVICE: 7/1/16 START TIME: 9:00am END TIME 10:00am FUNDING SOURCE: Medicaid State General Trust Fund Commercial insurance Anthem Key for services with no CPT code: NS=No show CCN=Care Coordination 00000=Misc Code #of units 4 1 CPT Code CCN Outcomes/Session Plan Mary made good progress this week. She was able to bend down from a standing position to pick up objects placed on the floor around her. She was able to imitate games such as Spring like a kangaroo. She was able to catch a small ball when it was gently thrown to her. See description of care coordination, page 8. RMHS to bill or Provider to bill RMHS RMHS Total Session Duration (mins.) 60 minutes Observations/Progress toward IFSP Goal(s): Mary is making significant progress towards meeting her IFSP goal around in engaging in various gross motor activities to increase her upper body strength, balance and coordination. Recommendations/Strategies: Continue with PT therapy on a weekly basis until the IFSP team meets during October 2015 at Mary s annual review to discuss her progress and any possible changes regarding her therapy and services. Provider Signature /Date: John Doe, 7/7/16 Supervising Staff Signature/Date (if applicable): John Doe 2, 7/7/16 **ATTN: Please convert this document to a PDF format before submitting securely to invoices@rmhumanservices.org Revised: 1/17 Page 22

23 Guidelines for Medical Record Documentation RMHS suggests following the guidelines for medical record documentation as recommended by the National Committee of Quality Assurance (NCQA). Consistent, current and complete documentation in the medical record is an essential component of quality patient care. To access the guidelines for NCQA suggested medical record documentation, click here: Appointment Cancellations and No-Shows A no-show is when the provider makes a good faith attempt to provide services (i.e., the provider is in route to the family s home) and the family is unavailable for a scheduled therapy session when the provider arrives to the place of the visit. The provider will be reimbursed for their time at one (1) unit per no show. This payment is contingent upon the provider notifying the service coordinator immediately after the service provider is aware of the missed appointment. The service provider must document the missed appointment on the progress note. No CPT code should be included on the documentation for the no show (for example, the service provider should not be invoicing for OT for the service date it should be invoiced as a no show) A provider will only be reimbursed for two (2) no-shows in a 6 month period per child. After the first no-show the service coordinator will contact the family. After the second no-show, the service coordinator will set up a meeting with the family to review the IFSP services and ensure all needs are being met. Funding Hierarchy Billing and Payment RMHS is required through Early Intervention Colorado to use the funding hierarchy. This means we must have providers in our network who accept reimbursement from private health insurance and Medicaid. We must always access these funding sources prior to using EI State or Federal Funding. We will send referrals with information about the child s funding source, and if you agree to take the referral, we will expect that you are prepared to either invoice that funding source yourself, or to submit invoicing through RMHS for that funding source. If you are invoicing your own services for a child with commercial insurance or Medicaid, you may only submit that child s invoicing for reimbursement by State General Fund (SGF) if it is accompanied by an Explanation of Benefit (EOB) that addresses the payment status from the funding source on the referral. Revised: 1/17 Page 23

24 Progress Note Submission Requirements If you are invoicing any services through RMHS, your progress notes serve as your invoice for payment. Progress notes must be received 30 days following the day in which service(s) were provided. If progress notes are not received by the invoicing deadline, payment will occur the following month.however, if notes are submitted beyond the 30 day deadline and RMHS is unable to recoup payment from outside sources, there is a risk of non-payment to the provider. Progress notes should be submitted electronically to invoices@rmhumanservices.org. Progress notes should be submitted in an encrypted or HIPAA compliant manner. If progress notes are incomplete, have inaccuracies, or are attempting to invoice for unallowable services, the progress note will be returned to the provider and payment could be delayed. An example of an incomplete progress note is if a CPT code is listed but there is no diagnosis listed. Revised: 1/17 Page 24