Chapter 238 School-Based Health Services

1. Chapter 238 School-Based Health Services Nursing Services Billing Form

2. Consent to Bill Medicaid • Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement. • Consent is valid for one calendar year from the signature date. • Parents are to be provided an annual notice.

3. Plan of Care • Services must be documented on the Plan of Care signed by the parent and therapist. • Effective August 1, 2019 Service Care Plan is now called a Plan of Care. This provides more consistency and avoids a terminology conflict with private school service plans. There is not a need to have a new one signed if it says Service Care Plan • The IEP Program has been adjusted to reflect the change in terminology. • 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. All appropriate diagnosis codes need to be listed on the Plan of Care. • A global code such as Autism would not be appropriate. • A copy of the nursing health care plan is to be included with the Plan of Care.

4. Physician Authorization Form • Nursing services are not included on the Physician Authorization Form as doctor orders are provided in conjunction with nursing services.

5. 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 nursing services. • 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.

6. Service Record – School Based Nursing Services Billing Form

7. Service Record – School Based Nursing Services Billing Form

8. Diagnosis Codes • Enter the specific ICD 10 Diagnosis Codes related to nursing services on the form starting with box number one. • Enter the codes that are directly associated with the services/or assessments.

9. ICD 10 Diagnosis Codes

10. ICD 10 Diagnosis Codes

11. Nursing Service Procedure Codes

12. Nursing Service Procedure Codes

13. Nursing Service Changes • *Diabetic Management – T1001 SE (2 Events/Calendar Year) • *Catheterization Self-Management – T1000 SE (Units)

14. Nursing Telehealth • Telehealth is now available for some procedures within T1000 SE: • Inhalation Therapy – Available for self-administration only with RN or LPN at main site • Catheterization Self-Management • Measurement of Blood Sugar – Available for self-administration • Subcutaneous Insulin Infusion by Pump – Available for self-administration • Subcutaneous Insulin Infusion by Injection – Available for self-administration • Peak Flow Meter Available only with RN or LPN at main site. • If using Telehealth an additional modifier is required of GT. So the CPT code would be T1000 SE GT. It is very important to enter the modifiers in that order.

15. Nursing Telehealth • Telehealth is now available for two procedures within T1001 SE: • Anaphylactic Reaction Assessment/Evaluation – Available for self-administration only with RN or LPN at originating site • Diabetic Management – Available for nurse supervision for self-administration • If using Telehealth an additional modifier is required of GT. So the CPT code would be T1001 SE GT. It is very important to enter the modifiers in that order.

16. Enter Claim Documentation • Use the CPT codes and caps from slide eleven to complete the claim documentation section of the billing form. • In the first column list the service date. (If combining minutes from different days for a unit use the date the 15th minute occurred to complete the unit. No span dates are allowed.) • Column two - enter one or more of the diagnosis code numbers that directly relates to the services. (examples 1, 1 & 3, 2) • Column three - enter the CPT code including a GT modifier if being provided by telehealth. It is very important to enter the modifiers in the correct order. The SE modifier must come first. Example -T1000 SE GT. • Columns four and five - enter the start and end time. • In the last column enter the total number of units or event(s).

17. Claim Documentation

18. Claim Documentation

19. Third Party Billing • At times a student may be eligible for Medicaid as the secondary insurance. • Medicaid is the payer of last resort for direct services (OT, PT, Speech, Audiology, Psychological, and Nursing). • If the student has special transportation services, the direct billing should be submitted. The claim will be denied but will justify claiming transportation billing for that instructional day. • Medicaid will pay ancillary services (TCM, personal care aide and special transportation) as the secondary insurance. • Occasionally a student may be eligible for Medicaid under two numbers. In this case district’s should always use the primary Medicaid number.

20. Signature and Credentials _____________________ ______________ Signature/Credentials Date

21. Signature and Credentials __Mary Smith ___ RN___October 1, 2019 Signature/Credentials Date

22. Additional Documentation • A copy of the student’s nursing notes for the month will also be required. • A copy must be on file in the special education central office.

23. Ashley Torres RN – School Health CoordinatorOffice of Special Educationatorres@k12.wv.us304-558-2696 ext 53536https://wvde.us/special-education/school-health/

24. Kelley Johnson – CoordinatorOffice of Special Educationkelley.johnson@k12.wv.us304-558-2696 ext 53539WVDE Medicaid Website:https://wvde.us/special-education/Medicaid/