Third Party Billing - FAQ - Licensed Clinical Professional Counselors

Friday, August 29, 2008
All schools operating on normal posted schedule.

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Frequently Asked Questions

Licensed Clinical Professional Counselors

What makes a child qualify for Third Party Billing? For a student to be eligible for Third Party Billing, they must have an active IEP and receive medical assistance benefits. For child to be eligible to receive Medical Assistance requires a number of things. One of which is the financial situation of the family. Another is if the child has a permanent handicapping condition. The family must apply for Medical Assistance. The local office of Department of Social Services accepts applications for Medical Assistance. If a student is in a foster home they are automatically qualified for Medical Assistance for six months. The parents should contact the Department of Social Services at 1-800 772-1213 to determine the eligibility of their children.
Do our services have to be on the IEP in order for us to bill? Yes, for a student to be eligible for Third Party Billing, all counseling services must be delineated in the IEP.
What is the difference in billing if we use code 01 or 90 for the time of service on the IEP? The time code on the IEP has no impact on the billing of the services provided by an LCPC.
Why does a consultation have to be a face-to-face contact with the student? Medicaid regulations stipulate that all services provided by licensed clinical professional counselors must be face-to-face contact with the child and specified in the child's IEP.
When would I use procedure codes in the 900 series? As an LCPC, you will not use any of the codes for billing. These codes are strictly designated for use by the case manager.
When should we submit these forms to the Office of Third Party Billing? Please send your encounter data forms into the Office of Third Party Billing at the end of each month.
How would we identify a student as having Medical Assistance? For a student to be eligible for Third Party Billing, they must have an active IEP and receive medical assistance benefits. You can assist in the identification process by sharing the Third Party Billing registration forms with parents. You may also send a note to Third Party Billing with the social security number and name of the student. We will investigate and inform you if the child is eligible for Medicaid.
When can we submit retroactive encounter data? For a student to be eligible for Third Party Billing, they must have an active IEP and receive medical assistance benefits. You can assist in the identification process by sharing the Third Party Billing registration forms with parents. You may also send a note to Third Party Billing with the social security number and name of the student. We will investigate and inform you if the child is eligible for Medicaid.
Can we submit encounter data if the service is provided by another counselor who is not an LCPC? In this instance you cannot submit data if the service(s) are provided by another counselor who is not an LCPC. You should only submit data for services that you have provided to the student on a face-to-face contact otherwise; the information on the encounter data form would be fraud. Your encounter data form must be have with an original signature. Your signature indicates all information on the encounter data form is correct. Medicaid regulations stipulate that all services provided by licensed clinical professional counselors must be face-to-face contact with the child and specified in the child's IEP.
I attend a lot of IEP Team meetings. Can I submit encounter data for these meetings? Only the Case Manager designated for the student can submit an encounter data form for case management services. If you provided as related service to the student on the same day as the IEP Team meeting, you may submit an encounter form for the service.
How should we select a diagnosis code? The diagnosis code that is selected should reflect the reason that you are seeing the child. In instances where the child qualifies for more than one diagnosis code, please select the most prevalent condition.
Does our diagnoses code have to match the diagnosis code used by the case manger? The diagnosis code that is selected should reflect the reason that you are seeing the child.
Can I bill if I provide an assessment for a child, and the child ends up with an IEP, but no counseling goals are on the IEP? Yes, in this instance you may bill for you assessment of the child. The assessment must be with the student in order to qualify as a billable service.
Where will I find counseling on the IEP? You can find counseling on the IEP under section D Nature of Service. There are four sections: Educational, Vocational, and Related Services and Additional Services. You can find counseling in the related services area.
Should we change our caseloads around so that the LCPC is providing services to the student's on this list? If the student has counseling services delineated in the IEP, you may provide services to the student's on your list.
Where will we find the middle initial of the student? You can find the middle initial of the student in the Columbia System or possibly in the student's confidential records.
Is the identification number always the social security number? No, the identification number is not always the social security number. The identification number could very well be a 003 or 001 number. In the past years, if a student did not have his social security number when registering at school, the school assigned him/her an identification number that was not attached to a social security number.
Can we document a service on a day that school is closed? Medicaid regulations stipulate that all services provided by licensed clinical professional counselors must be face-to-face contact with the child and specified in the child's IEP.
How can we get the school number? The school number is a four-digit number that helps other schools/offices identify your school immediately. You may find this information on the list of eligible students sent to you monthly, in the school telephone directory or the secretary at your school can give you the information.
Can our diagnosis code change? Yes, the diagnosis code can change depending on who is seeing the child for services. The diagnosis code that is selected should reflect the reason that you are seeing the child. In instances where the child qualifies for more than one diagnosis code, please select the most prevalent condition.
What parts of the encounter data form can we photocopy? You may photocopy only the top portion of your encounter data form. It is very important to make sure your information on the top portion of the encounter data form is correct in order to avoid reoccurring errors. Errors will result in the encounter data form being returned to the IEP Chair each month. You may complete the top portion of the encounter data form and then make copies. I would suggest only making a few copies at first to see if any problems arise when the data is entered.
When will we start receiving our monthly printouts? On a monthly basis, the Office of Third Party Billing will send a report to your school that will delineate which students qualify for the Third Party Billing program. You should receive a report around the 20th of November.