Frequently Asked Questions
The Division of Behavioral Health (DBH), formerly the Divisions of Alcohol and Drug Abuse and Comprehensive Psychiatric Services, is making available responses to frequently asked questions related to CPR and TCM. We will continue to add questions to this list as they become available. We advise you to check back periodically for updates.
1. Q: When a child is in the Intensive CPR program and is admitted to an inpatient psychiatric hospital, can we bill intensive CPR on the date of admission and the date of discharge from the hospital? If not, how should the direct care services provided on those dates of service be billed?
A: (Medicaid inpatient billing) While this attachment does not address intensive level of CPR, it is appropriate to bill the date of admission, and date of discharge to the intensive level when a child is admitted to an inpatient psychiatric hospital.
2. Q: With the new PSR services that are available for kids and their parents, is it possible to have a PSR group for the children going on at the same time/date that a PSR group for the parents is occurring? Example: at 4 p.m. – 6 p.m. the children’s PSR was going on in one room so we would bill 2 hours of PSR. At the same time, the parents are in a PSR group for 2 hours with a different staff member. Can we bill 4 hours of PSR on this day on the child that is the patient?
A: Yes, you can bill in the manner you describe. But you will have to bill the PSR service for the child and parent on the same date and both services cannot exceed six hours. If billed on separate dates, as I am sure you are already aware, the system will kick out the service billed on the later date.
3. Q:Some of the staff are saying that they believe there is a mandate to have monthly contact with our youth consumers that are in residential treatment and to bill TCM for that contact. We really felt the need to double check that, as it seems like a lot of travel time to be billed for – for what amounts to a very short face to face visit. Is this an actual mandate, or can we do it on a case by case bases, if it is necessary for our staff to attend a meeting at the Residential facility etc. Typically these are kids that have Medicaid, but we can not bill CPRC, as they are not actively receiving services, but may be in SCL.
A: It is expected that the CMHC's will maintain contact with a child while they are in a residential treatment center. It is not specified in the TCM provider manual nor in the TCM State Plan that the contact has to be a face to face visit, nor is the frequency of the contact specified. The specific residential treatment center as well as the child's clinical profile and support system should be considered by the CMHC when determining the kind of contact (face to face or by phone) and frequency that is maintained.
4. Q: We have always been told that if we make several phone call attempts, and then finally connect with a Parent, that we can “lump” the time for the attempts and the conversation in one note and add the times together. So, for a concrete example… January 20: Attempted phone call, 1 min. at 9 am Attempted phone call, 1 minute, 10 am Attempted phone call, 1 minute, 11:30 am Successful phone contact, talked with Mother for 10 minutes, at 12 pm. We would bill this in the following manner. TCM, date of service - January 20, 2009, duration of activity = 13 minutes, we would bill this as one unit of TCM = 15 minutes. In this example, how do we bill the “exact” times on this type of billing, or can we no longer “lump” as we have been allowed in the past.
A: While the billing system tracks the day of service and in some cases total hours of contact per day, it does not track the exact clock time. It is the child’s record where you will have to document the exact clock time as well as the day and other Medicaid requirements. As a result, your example above is an appropriate way of documenting the various attempts as well as the actual one on one communication with the mother.
5. Q: The second “lumping question… if during the course of a school day, one of my School-based folks talks with a Teacher, Principal, and Parent, regarding a consumer regarding a specific issue, when billing this service, is it still allowable to “lump” the 3 conversations together, or must these all be billed and documented separately? Again, the need to use actual clock time is our concern.
A: Same principle above applies.
6. Q: When we do an Annual or Initial Psychosocial Assessment, we do not bill the transaction until all the documentation is done and in the record. The CSW’s accompany the client in the assessment interview and take an active role in this process. Is it allowable to have the CSW bill for the time they are with the client during the interview since the time is not billed yet for the Assessment? The supervisor will document the interview was conducted, who was present, where it took place etc, but the actually billing for the event may not be for one and one half weeks until the full document is completed with all signatures. At that time, the billing for the event will occur with the date it was reviewed and submitted.
A: No, you cannot bill for any CSW time that was spent in the course of completing the intake or annual CPR assessment, or, for that matter, any time they spend on the required quarterly ITP reviews. The CPR assessments are a bundled rate, and the payment is inclusive of all the time that the team members spend putting the assessment together, including the CSW, the QMHP, and the physician (for the consultation). In addition, the cost of the quarterly reviews is also built into that same rate.
7. Q: I was wondering if the Family Support Provider could provide family education classes for the parents of children in our services.
A: The answer is no. It is part of the Family Support Worker’s job duties to provide one on one education to a parent of a child that is in CPR as per the treatment plan. It is a different matter to provide generic group style education to parents that may not even be on this person’s case load.