Billing Guidelines. PBS shall prepare all bills and claim forms for Services provided by Client pursuant to the Billing Guidelines set forth in the attached Appendix B.
Billing Guidelines. PBS, in its sole discretion, shall make all billing decisions, including, but not limited to, decisions on the level of service billed and determination of medical necessity. Such decisions shall be made based on the guidelines, policies and regulations issued by Medicaid, Medicare, or other third party payer.
Billing Guidelines. Deleted: 2 Rev – 8/23 Unless otherwise specified herein the term "unit" in Schedules A and B is defined to mean a fifteen (15) minute episode of service with the client present in compliance with the applicable Administrative Rule. The Mental Health Board shall pay the authorized unit rate for each fifteen (15) minutes of qualifying client Service identified on the Work Plan by service or activity code that has been provided and is properly documented and submitted for payment. An episode of Service lasting at least eight (8) minutes but less than fifteen
Billing Guidelines. Unless otherwise specified herein the term "unit" in Schedules A and B is defined to mean a fifteen (15) minute episode of therapy with the client present or assessment and case management type Services in compliance with the applicable Rule 132 or 2060. The Mental Health Board shall pay the Authorized Unit rate for each fifteen (15) minutes of qualifying client Service that has been provided and is properly documented and submitted for payment. An episode of Service lasting at least eight (8) minutes but less than fifteen (15) minutes shall be paid an amount equal to the Authorized Cost Per Unit. An episode of Service lasting less than eight (8) minutes shall not qualify for any payment. Units lasting less than 8 minutes shall not be added together to meet the billable unit time requirement. The Mental Health Board will not pay for documenting client encounters or for the completion of paperwork and documentation that does not involve direct client contact or Services. The Mental Health Board shall pay the Authorized Unit rate for each qualifying client Service that has been provided and is properly documented and submitted for payment. The unit rate is specified in each Schedule. Payments for the Grant and the Fee for Service Agreements shall be made on a monthly basis commencing with the month of December 2013, payable in January 2014, and each and every month thereafter, upon submission by the Provider of a satisfactory monthly Affidavit and documentation of Services delivered. Provider shall make no change to the Affidavit template supplied without written permission from the Mental Health Board.
Billing Guidelines. The HSC includes a review of the patient’s relevant history, relevant family history and relevant history of present complaint, and a review of any laboratory data, PACS images, medical records or other data as needed to provide advice. The health service includes a discussion of the relevant physical findings as reported by the referring provider. The Consultant Physician HSC is not reportable in addition to any other service for the same patient by the same physician on the same day. The Referring Physician HSC may be reported when the communication with the consultant physician occurs on the same day as a patient visit -or other service. The HSC is not reportable when the purpose of the communication is to: - Arrange transfer - Arrange a hospital bed for the patient - Arrange a telemedicine consultation - Arrange an expedited face to face consultation - Arrange a laboratory, other diagnostic test or procedure - Inform the referring physician of the results of diagnostic investigations - Decline the request for a consultation or transfer the request to another physician The service is reportable only when the communication is rendered personally by the physician reporting the service and is not reportable if the service is delegated to another health professional such as: - Nurse practitioner - Resident in training - Clinical fellow - Medical student The service is not reportable for telephone calls or face to face conversations of less than 5 minutes of two way medical discussion. Documentation Requirements • The referring physician must document that the referring physician has communicated the reason for the consultation and relevant patient information to the specialist. • Both the specialist consultant and the referring provider must document the patient name, identifying data, date and encounter time in their respective charts or EMRs. • The names of the referring physician or provider and the consultant physician must be documented by both physicians. • The diagnosis, reason for referral, elements of the history and physical as relayed by the referring provider, the opinion of the consultant physician and the plan for future management must be documented by the referring physician and the specialist. • A written report must be sent to the referring provider by the specialist consultant. • The referring physician’s billing number must be noted on the claim from the consultant. This is not required for the referring physician’s claim.
