The following frequently asked questions provide details on the most commonly asked about pieces of the Medicaid Services Report feature. Click a question from the list here to navigate directly to the corresponding answer, or scroll through the full list of questions and answers below.
Half Month (aka Partial Month) billing for ACT requires two Face-to-Face contacts with the client on two different service days documented in Service Plan Linked Notes. No more than one of these contacts can take place in the hospital, and neither of the notes can be Collateral Contact notes. Each contact needs to have a duration of at least 15 minutes.
Full Month (aka Intensive Level) billing for ACT requires 6 Face-to-Face contacts documented in Service Plan Linked or Collateral Contact notes. Up to three of the contacts in a given month can be collateral notes. Two services can be provided on a single date of service only if one is with the client (documented in a Service Plan Linked Note) and the other is with collaterals (documented in a Collateral Contact Note). No more than two of he contacts can take place in the hospital. Each contact needs to have a duration of at least 15 minutes.
Hospital (aka Inpatient) can be billed if the client does not meet the requirements for Full or Half month billing. There must be at least two 15 minute contacts with the client, on different days documented in Service Plan Linked Notes.
All of the above listed rules apply to the Medicaid Service Report and to invoices generated for ACT services via the BillingBuilder.
For Half Month billing, the client needs 11 days in residence out of the hospital, and two service plan linked notes. For Full Month billing, the client needs 21 days in residence out of the hospital, and four service plan linked notes. Additionally, the client must have a Medicaid entitlement and an Authorizing Provider in effect.
A second-half bill is used when someone is in the residence only for the second-half of the month. They must be admitted after the 15th and have over 11 bed nights. It's not based on when services were rendered. So, even though a resident may have received two services in the second-half of the month, if he was admitted prior to the 15th of the month, he is still billed for the first-half of the month.
The Medicaid Services Report pulls Medicaid numbers off of certified entitlement records. It will include Medicaid numbers that have since been closed out as long as the closure date is in the last 15 days.
Only two or four services will show on the report in accordance with Medicaid billing regulations for half and full month eligibility. In other words, because only two notes are needed for half month billing, only two will show if the client's days in residence are only going to permit half month billing. Similarly, because only four notes are needed for full month billing, only four will show on the report for full month billing, even if the client had more.
Hospitalization records for which the type is set to "ER-Psych" or "ER-Med" are not counted on this report. AWARDS does not consider ER records to be reflective of a day out of the program.
In order for the report to recognize the authorizing physician, the record for that physician in Support Services Contacts or Providers must have an "as of" date or "Start Date" (and "end" date if applicable) showing he/she was effective during the month for which the report was run. If no "as of"/"start" date exists, or if the "as of" and "end" dates indicate that the contact was not in effect for the client during the report's timeframe, AWARDS will not pull that authorizing physician into the report.
In general it is always important that "as of," "start" and "end" dates be maintained in a client's support services contacts and providers records, particularly in those used for billing.
When the number of days in residence appears to be incorrect, begin troubleshooting by checking the client's hospitalization records. Typically this type of problem results from there being multiple hospitalization records for the client without end dates on them. If the hospitalization records are cleaned up, the report information should be adjusted automatically.