interim guidelinesfor fifteen- minute billingfor targeted（临时guidelinesfor十五分钟billingfor目标）.docVIP

Guidelines for Children’s Targeted Case Management Services for Behavioral Health and Developmental Disabilities under MaineCare Benefits Manual, Section 13 Emergency Rule effective August 1, 2009. Registration/Prior Authorization and Continuing Stay Review: APS Healthcare has issued directions for registration and continuing stay reviews. Please see: Fifteen-minute billing guidance. Please refer to MaineCare Benefits Manual, Section 13.09-1 of the emergency rule. All submissions for reimbursement must have an accompanying progress note in the client’s chart including the specific amount of time (number of minutes) spent on the encounter. The actual minutes billed for any one case manager in a work day may not exceed the hours that case manager actually worked on that day. Initial encounter: The first service activity of the day can be counted as one 15 minute Unit of Service if it is a substantive encounter even if it is less than 15 minutes. A substantive encounter is an activity consistent with the guidelines set forth for covered services in paragraph 6 below. A subsequent encounter for the day is not required. ? Second and subsequent encounters: Case managers must total the amount of time of covered service for each client during a day and determine the amount of billable units for the client. The time for second and subsequent encounters are added together. The following sets forth allowable billable units per number of minutes of service per client per day for second and subsequent encounters: Units Time 1 Greater than or equal to 7.5 minutes but less than 23 minutes. 2 Greater than or equal to 23 minutes, but less than 38 minutes 3 Greater than or equal to 38 minutes, but less than 53 minutes 4 Greater than or equal to 53 minutes, but less than 68 minutes 5 Greater than or equal to 68 minutes, but less than 83 minutes 6 Greater than or equal to 83 minutes, but less than 9