11 Third Party Billing For Related Services Providers
11 Third Party Billing For Related Services Providers August 2019
Related Service Providers What is Third Party Billing? What is a claim? • Federally funded program • Records a billable service rendered to a student with special needs • Pursues Medicaid reimbursement of some costs of direct and administrative services under IDEA • Submits Medicaid claims to recover costs of some medicalrelated services provided to children who receive specialized services. 2 • 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.
Related Service Providers What is a false claim? • Federal Offense • Contains any of the following false info Ø Incorrect student Ø Service did not occur Ø Provider reporting the service did not render the service Ø Incorrect or false date of service Ø Incorrect or false type of service 3 Who can provide services? • A clinician currently licensed by Maryland Department of Health: Ø Ø Ø Ø 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: Ø Advanced Professional Certification Ø Standard Professional Certification
Related Service Providers How do I get to the Third Party Billing web site? Go to the City Schools’ website. Select Staff Member. 4
Related Service Providers How do I get to the Third Party Billing web site? Scroll down to Popular Pages. Select Third Party Billing. 5
Related Service Providers How do I get to the Third Party Billing web site? Select TPB/SAS System. 6
Related Service Providers How do I log in? Logon using your network ID and password. 7
Related Service Providers 8 Your Promise Before each use, you promise to not commit Medicaid fraud. Report your services only.
Related Service Providers 9 Assessments can be billed whether a student is found eligible or ineligible for an IEP, but the eligibility meeting must have been held and closed.
Related Service Providers Assessments Type the student’s pif, last name, or first name. Click the student’s name. 10
Related Service Providers 11 Assessments Click Get Data. Student information is populated from Maryland Online IEP and cannot be changed. This information will not populate if the student has transferred, exited, or has an IEP still in draft.
Related Service Providers Assessments Select the type of service you provided from the Procedure Code drop down list. This student was given an audiological assessment. 12
Related Service Providers 13 Assessments Use the calendar widget to select the assessment date. Only one face-to-face date per assessment can be billed.
Related Service Providers 14 Assessments Select the Diagnosis Code from the drop down list. It explains ‘why’ you assessed the child, not the outcome of the assessment. Your report will address your findings.
Related Service Providers 15 Assessments Indicate that your report has been signed and dated. We remind you to place the report in the confidential folder and upload it to Maryland Online IEP. Click Submit.
Related Service Providers 16 Assessments Verify your data. If correct, click Submit. If incorrect, click Back and make corrections. Your assessment has been entered successfully.
Related Service Providers Reports Select Reports. Six months of data are available. 17
Related Service Providers 18 Reports Transaction History Report opens in a new window. It displays services for the loggedin 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.
Related Service Providers Transaction History Reports Save trees. Do not print these reports. Close both report tabs to return to the Reports Menu. 19
Related Service Providers 20 Frequently Asked Questions Who is a related service provider? A related service provider is a currently licensed and/or certificated City Schools or contractual audiologist, social worker, speech/language pathologist, psychologist, occupational or physical therapist, psychiatrist, licensed clinical professional counselor or nurse who provides direct medical services to students pursuant to special education. How are services submitted to Third Party Billing? The Office of Related Services submits an electronic file of Encounter Tracker (ET) services. ET submissions to Third Party Billing do not include clinical notes. Are indirect services, such as consultations, billable? No. Third Party Billing cannot bill for indirect IEP services. Can I bill for 504 and service Plan students? No. Third Party Billing cannot bill for students with a 504 or Service Plan.
Related Service Providers 21 Frequently Asked Questions What are my responsibilities as a related service provider? • Submit IEP services data via Encounter Tracker • Write a descriptive clinical note • Watch your dates! The date on the clinical note must match the service date in ET. Services on days when school is closed must be supported by professional notes. • Verify student attendance • Report services via the Third Party Billing System: • Assessments – Students must have had an evaluation meeting. • Service Coordination (for Speech Only students) • Infants and Toddlers (IEP and IFSP) • Place appropriate supporting documentation in the student’s confidential folder • Provide coordination of care consistent with the intent of the IEP • Participate in the planning and implementation of the IEP • Report all services by the last day of the month in which they occur.
Related Service Providers 22 Infant & Toddler IFSP Services Meetings, Assessments, Therapy & Service Coordination
Related Service Providers 23 Meetings, Assessments, Therapy & Service Coordination Select IFSP from the menu. Student information comes from Maryland Online IFSP Birthto-Five. You cannot use the Medical Assistance Number to locate the student. Search using Last Name, First Name, or Child. ID, then click Get Student Information.
Related Service Providers 24 Meetings, Assessments, Therapy & Service Coordination Services previously entered for the student are shown.
Related Service Providers 25 Meetings, Assessments, Therapy & Service Coordination To report an Assessment, use the Assessment Date widget and leave Service Date blank. To report an IFSP meeting, therapy, or service coordination, use the Service Date widget and leave Assessment Date blank.
Related Service Providers 26 Meetings, Assessments, Therapy & Service Coordination Select the Procedure code.
Related Service Providers 27 Meetings, Assessments, Therapy & Service Coordination Select the Diagnosis code, then enter time in minutes.
Related Service Providers 28 Meetings, Assessments, Therapy & Service Coordination Submit and review your entry. Assessment Date is blank for therapy. Submit if correct. Click Back to make corrections.
Related Service Providers 29 Meetings, Assessments, Therapy & Service Coordination The service is reported. Enter another service for Daylen or clear the form to search for another student.
Related Service Providers 30 Meetings, Assessments, Therapy & Service Coordination Under the Reports Tab, select 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.
Related Service Providers Service Coordination for Speech-only Students 31
Related Service Providers Service Coordination for Speech-only Students Medicaid cannot be billed without the parent’s consent. Go to the Reports tab. Click Consent Form Creator. 32
Related Service Providers Service Coordination for Speech-only Students Search for by student ID, last name, or first name. Highlight the student’s name and click to select. 33
Related Service Providers 34 Service Coordination for Speech-only Students 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.
Related Service Providers 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. 35
Related Service Providers 36 Service Coordination for Speech-only Students Your name is displayed here. Click the SC tab. Report services that you provided.
Related Service Providers Service Coordination for Speech-only Students If your student is not listed, Search Students. You may need to scroll down to get to the button. 37
Related Service Providers Service Coordination for Speech-only Students Type the student’s pif, last name, or first name. Click the highlighted entry, then Search to pull your student. 38
Related Service Providers Service Coordination for Speech-only Students Mouse over Update to use the hyperlink. Click Update to enter services. 39
Related Service Providers Service Coordination for Speech-only Students Reported services are displayed. Student info is from Online IEP and cannot be changed. 40
Related Service Providers Service Coordination for Speech-only Students Use the calendar widget to select the date you provided the service. 41
Related Service Providers Service Coordination for Speech-only Students Use the drop down list and click the service you provided. First service of the year is Sent Parental Consent Letter. 42
Related Service Providers 43 Service Coordination for Speech-only Students Outcome Statement is automatically generated. Click submit to promise to place supporting documentation in the student’s confidential folder.
Related Service Providers Service Coordination for Speech-only Students Verify the information you entered. If correct, click Submit. If incorrect, click Back and make corrections. The service has been reported. 44
Related Service Providers 45 Service Coordination for Speech-only Students Go to the Reports tab and click on a report. The Transaction History Report lists your reported meetings for two quarters.
Related Service Providers 46 Service Coordination for Speech-only Students 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.
Related Service Providers Service Coordination for Speech-only Students SC Report displays ‘ 1’ for reported services. Missing services are indicated by ‘. ’. Report end date is previous month. TPB Compliance percent has been added. 47
Related Service Providers 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. 48
Related Service Providers 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. 49
Related Service Providers Third Party Billing Call Third Party Billing at 410 -396 -8948 for TPB System and Provider Support. Information Technology will not be able to assist you with TPB System issues. 50
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