Provider Billing Procedures 535-05-45

(Revised 1/1/10 ML #3215)

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The personal care service provider is responsible for keeping written records documenting the delivery of care to each individual. The written record must include the date, the tasks performed, and the time required to perform the tasks.

 

The approved services on SFN 662 must identify the procedure code the provider is to use to bill for services provided.

 

A personal care service provider who is enrolled as a QSP must use the Turnaround Document for Home and Community Based Care for the Elderly/Disabled (TAD), SFN 925, or the QSP online billing option to bill for services. A personal care service provider enrolled as a basic care assistance provider must bill using the Basic Care Assistance Turnaround Document. Only one (1) procedure code per individual may be entered in any one section on the TAD. Procedure code T1019 must be used be used to bill on a 15-minute increment basis.  Billing is limited to the time in performance of the authorized tasks provided. The provider must bill in 15-minute increments on a daily basis.  Each 15-minute increment is one (1) unit and the number of units of service provided on each day of care must be shown on the billing document. Procedure code T1020 must be used to bill a daily rate for a provider authorized to bill a daily rate. Only 1 unit per client may be billed per day for procedure code T1020. The provider may be paid the daily rate only for days on which personal care services were provided. The daily rate may not be paid for any days on which the individual was in the hospital or a health-care facility or on leave from the residence, except payment is allowed for the day the individual returns to the providerís care. Payment may be claimed when personal care services are provided on the day of death.

 

Case Managers should determine units in each of the five categories of ADL, Medication Assistance, Meal Preparation, Laundry/shopping/housekeeping, and Other.  Some flexibility is anticipated in the provision of tasks amongst the categories of ADL, Other, Meal Preparation and Medication Assistance and the provider is allowed to bill up to the total units approved; however, the provider may not bill for units in excess of the units authorized in the category of laundry, shopping and housekeeping.