Third Party Billing

1. Third Party Billing For IEP Team Associates August 2019

2. IEP Team Associates What is a claim? Records a billable service rendered to a student with special needs Identifies recipient of service, date of service, type of service, diagnosis code, provider of service, and amount charged for the procedure Same as the claim submitted by your physician to your health insurance after an office visit. What is Third Party Billing? • Federally funded program • Pursues Medicaid reimbursement of some costs of direct and administrative services under IDEA • Submits Medicaid claims to recover costs of some medical-related services provided to children who receive specialized services.

3. IEP Team Associates Who can provide services? A clinician currently licensed by Maryland Department of Health: Occupational Therapist Physical Therapist Speech/Language Pathologist Audiologist Social Worker Psychologist Licensed Professional Counselor A clinician currently certified by the Maryland State Department of Education: Advanced Professional Certification Standard Professional Certification What is a false claim? • Federal Offense • Contains any of the following false info • Incorrect student • Service did not occur • Provider reporting the service did not render the service • Incorrect or false date of service • Incorrect or false type of service

4. IEP Team Associates How do I get to the Third Party Billing web site? Go to the City Schools’ website. Select Staff Member.

5. IEP Team Associates How do I get to the Third Party Billing web site? Scroll down to Popular Pages. Select Third Party Billing.

6. IEP Team Associates How do I get to the Third Party Billing web site? Select TPB/SAS System.

7. IEP Team Associates How do I log in? Logon using your network ID and password.

8. IEP Team Associates Your Promise Before each use, you promise to not commit Medicaid fraud. Report your services only.

9. IEP Team Associates How do I report IEP meetings? For your assigned schools, meetings to report are marked . Mouse over Report Meeting for the hyperlink that will take you directly to the entry screen.

10. IEP Team Associates How do I report IEP meetings? All information presented is from MD Online IEP and cannot be changed. Verify Meeting Date, select Type of Meeting, click Placed In Folder, and Submit.

11. IEP Team Associates How do I report IEP meetings? Use the confirmation screen to review your information. Once you click Submit, Type of Meeting can be changed by Third Party Billing only. If correct, click Submit. Otherwise, click Back to make a correction.

12. IEP Team Associates How do I verify a reported IEP meeting? Here is verification that your meeting has been reported and the student is no longer listed. As this was the only meeting for this school, there is no report to display.

13. IEP Team Associates How do I view reports? Go to the Reports tab and click on a report. The Transaction History Report lists your reported meetings for two quarters.

14. IEP Team Associates How do I view reports? Transaction History Report opens in a new window. It displays services for the logged-in provider. Choose Current Month, Current Quarter, or Prior Quarter and click Run. If you do not get a report, click on the box with the red ‘X’. Allow pop-up blocker for SAS. Click Done, then Run.

15. IEP Team Associates Transaction History Report Save trees. Do not print these reports. Close both report tabs to return to the Reports Menu.

16. IEP Team Associates Missing IEP Meetings Missing IEP Meetings Report displays all billable meetings. If all meetings are entered, there is no report. Meetings appear when they have been finalized in Maryland Online IEP. If your school has a large Specialized Services population, check this report weekly.

17. IEP Team Associates Service Coordination Report Displays ‘1’ for services reported for students. Missing services are indicated by ‘0’. Report end date is previous month. Patterns of zeros may indicate unreported services by a specific provider.

18. IEP Team Associates School Transaction History Report School Transaction History Report displays services for students reported by all providers at the school. Available for Current Month, Current Quarter, and Prior Quarter. All of your assigned schools will be displayed.

19. IEP Team Associates Compilation of Services Reported during this session When you select the Log Out tab, you get a summary of your session activity.

20. IEP Team Associates Sample IEP Team Attendance Sheet

21. IEP Team Associates Frequently Asked Questions What are the TPB responsibilities of the IEP Team Associate? • Serve as Chairperson of the IEP Committee for meetings held at your school(s) • Report all finalized IEP meetings • Resolve meeting discrepancies reported by TPB as missing each month • Submit copies of all Parental Consent Letters that are signed by the parent(s) or guardian(s) • Print student’s attendance and place a copy in their confidential folder. Do this quarterly. What documentation must be placed in the student’s confidential folder for Medicaid billing? • Completed Maryland Online IEP • Completed IEP Meeting Attendance Sheet • Copy of Notice of Invitation to the Parent How will I know my services have been reported to TPB? • Verification is provided after the 2nd submit, at the end of your session when you click on the Log Out tab, and via the Reports function.

22. IEP Team Associates IEP: Behavioral Intervention Section

23. IEP Team Associates IEP: Behavioral Intervention Section - Comments

24. IEP Team Associates IEP: Supplementary Aids, Services, ProgMods & Supports

25. IEP Team Associates IEP: Supplementary Aids, Services, Prog Mods & Supports

26. IEP Team Associates IEP: Nature of Service

27. IEP Team Associates Nursing Services • Nursing services are skilled nursing services performed by a licensed nurse (RN or LPN) for a participant, which are medically necessary for the participant to benefit from educational or early intervention services. • Services must be related to an identified health problem, ordered by a licensed prescriber, indicated in the nursing care plan, which is reviewed at least every 60 days and more frequently when the child's medical condition changes, and require the judgment, knowledge, and skills of a licensed nurse. • The limit for nursing services is eight (8) units per day, as 1-unit equals 15 minutes.

28. IEP Team Associates Nursing Services Do Not Include: • Routine assessments of participants whose medical condition is stable, unless the assessment is ordered and listed in the IEP/IFSP and leads to an intervention or change in the nursing care plan; • Administration of medications; • Supervision of interventions that the child is able to perform independently; • Health screens; • Health education, except one-on-one training regarding self-management of the child's medical condition; • First aid interventions; • Services not deemed medically necessary at the initial assessment or the most recent nursing care plan review; • Delegation of any services.

29. Service Coordinators Printing the Parental Consent Letter Medicaid cannot be billed without the parent’s consent. Go to the Reports tab. Click Consent Form Creator.

30. Service Coordinators Printing the Parental Consent Letter Search for by student ID, last name, or first name. Highlight the student’s name and click to select.

31. Service Coordinators Printing the Parental Consent Letter Select the language. Click Create Form. Verify the student’s information, which will be pre-printed on the letter. All student information must be printed from the system. There are no exceptions.

32. Service Coordinators Printing the Parental Consent Letter If you are the Primary Service Coordinator for the student, this letter must be completed and distributed before any services can be reported for billing. Print your name and the names of two (2) alternates. Sign. All signers must have Standard or Advanced Professional MSDE Certification. Make a copy and give the original to the student for the parent’s signature. After the parent signs, send a copy to Third Party Billing Room 201.

33. Service Coordinators Reporting Service Coordination Your name is displayed here. Click the SC tab. Report services that you provided.

34. Service Coordinators Reporting Service Coordination If your student is not listed, Search Students. You may need to scroll down to get to the button.

35. Service Coordinators Reporting Service Coordination Type the student’s pif, last name, or first name. Click the highlighted entry, then Search to pull your student.

36. Service Coordinators Reporting Service Coordination Mouse over Update to use the hyperlink. Click Update to enter services.

37. Service Coordinators Reporting Service Coordination Reported services are displayed. Student info is from Online IEP and cannot be changed.

38. Service Coordinators Reporting Service Coordination Use the calendar widget to select the date you provided the service.

39. Service Coordinators Reporting Service Coordination Use the drop down list and click the service you provided. First service of the year is Sent Parent Service…Form.

40. Service Coordinators Reporting Service Coordination Outcome Statement is automatically generated. Click submit to promise placing supporting documentation in the student’s confidential folder.

41. Service Coordinators Reporting Service Coordination Verify the information you entered. If correct, click Submit. If incorrect, click Back and make corrections. The service has been reported.

42. Service Coordinators How do I view reports? Go to the Reports tab and click on a report. The Transaction History Report lists your reported meetings for two quarters.

43. Service Coordinators How do I view reports? Transaction History Report opens in a new window. It displays services for the logged-in provider. Choose Current Month, Current Quarter, or Prior Quarter and click Run. If you do not get a report, click on the box with the red ‘X’. Allow pop-up blocker for SAS. Click Done, then Run.

44. Service Coordinators Transaction History Report Displays services for students reported by the logged in provider. Available for Current Month, Current Quarter, and Prior Quarter. Save trees. Do not print these reports. Close both report tabs to return to the Reports Menu.

45. Service Coordinators Service Coordination Report SC Report displays ‘1’ for reported services. Missing services are indicated by ‘.’. Report end date is previous month. TPB Compliance percent has been added.

46. Service Coordinators Printing the Service Coordination Activity Log • The Service Coordination Activity Log and supporting documents should be placed in the student’s folder when any of the following occurs: • Student transfers mid-year; • Student is dismissed from service mid-year; • School year ends. • Select the SC tab. Find your student. Hold Ctrl –P and click print.

47. Service Coordinators Review of Session Activity If your session has not expired, when you select the Log Out tab, you get a summary of your session activity.

48. Service Coordinators Frequently Asked Questions What are examples of billable service coordination? Billable service coordination may include: • Meetings/conferences with child or parent/guardian; • Progress reports/IEP report cards; • Letters concerning the student’s IEP progress; • Telephone calls…NOT messages left on an answering machine; • Home visits; • Emails (printed). Who can be a service coordinator? A Special or Regular educator who is most familiar with the student’s needs, who coordinates the student's IEP, and is certified by the state of Maryland with a Standard or Advanced Certificate. Related Service providers with Speech only students are service coordinators for those students.

49. Service Coordinators Frequently Asked Questions Can a student have more than one service coordinator? No. The student must have one primary and at least one alternate coordinator. The primary service coordinator must be certified, identified on the IEP by name and title, and approved by the student’s parent/guardian. The alternate service coordinator(s), also certified, should appear on the Service Coordination/ Medical Assistance Coordination Consent letter sent to the parent. The primary coordinator is expected to provide services and enter service details in the Third Party Billing System. What are the responsibilities of the service coordinator? • Provides coordination of care compliant with the IEP; • Makes contact with the parent/guardian and/or student throughout each month; • Participates in the planning and implementation of the IEP; • Places appropriate supporting documentation of services in the student’s confidential folder; • Reports service details in the Third Party Billing System by the last day of the month in which services occur. • Sends a copy of the Service Coordination/ Medical Assistance Service Coordination Consent Form to Third Party Billing after the parent signs it;

50. Service Coordinators Frequently Asked Questions Under what conditions should service coordination be reported to TPB? • The student must have an IEP. Service coordination cannot be billed for students who are not enrolled in special education; • There has been a direct contact (by meeting, visiting, telephoning, or writing) with the parent, guardian, or student; this direct contact occurs expressly to coordinate the IEP. When can the Parental Consent Form be sent home? On the student’s first day on your case load. How will I know my services have been reported to TPB? Verification is provided after the 2nd submit, at the end of your session when you click on the Log Out tab, and via the reports function. Can I bill for 504 or Service Plans? No. Students with 504 Plans or Service Plans are not billable.