LIEarlyInterventionProviderOrientation

SERVICEPROVISION

GettingStaffedonacase:

StaffingwillreachouttoyourAchieveBeyondemailorcallyoutoseeifyouareavailabletoaccommodateacase(youcanalsoreachouttostaffingwithyouravailabilitythruemailifyouhavenotreceivedacall)------Listaffing@achievebeyondusa.com

Onceprovideragreestotakethecase,staffingwillsendcaseinformationtoyourcompanyemailwithallinformation

Providerwillhavetocontactfamilyandsetupaschedule-alwaysinformstaffingofarrangementsthatweremadewithin24hoursofreceivingcase

Casemanagementwillbeintouchinregardstopaperwork(seenextslide)Ifyoudidnotreceivepaperwork,pleasefollow-upwithcasemanager

1.Youwillreceiveane-mailpacketfromtheCaseManagementteamincluding:IFSP,Evaluation,ServiceAuthorization,ServiceAgreement,EISessionNote

2.ReviewthepacketandfamiliarizeyourselfwithchildbackgroundinformationandIFSPobjectivesandthecontentofthepre-filledsessionnote.(mustreceiveemailfromcasemanagementthatincludesPacketbeforestarting)

3.ChecktheAchieveBeyondServiceAgreementforalistofprogressreportduedates

4.Contactfamilywithin24hoursofreceivingIFSPpacket,andarrangeforfirstsessionwithfamily

5.Youmuststartserviceswithin3daysoftheserviceauthorizationapprovaldate,andreportstartdatetoCaseManagerwithin24hours.

ContactCaseManagerwithin24hours,ifyouareunabletoreachthe

parent/guardian.

ToensureservicesareprovidedasperthefrequencyanddurationauthorizedintheIFSP:

The3-daywindowonlyappliestonewcases.

NewCasesvs.Re-StaffedCases

NewCases• Whenassignedtonewcase,theprovidermuststartwithin3daysoftheauthorizedIFSPdate.

Re-StaffedCases• Whenassignedtoacasethathasbeenre-staffed,theprovidermustcontactthefamilyassoonashe/shereceivesthecase&immediatelystartwhenyoureceivetheauthandpaperwork.

SuffolkCounty•  ProvidersareresponsibleforProgressReports

every3months.•  Every6monthreportmusthavetestingresults

andtestingdate•  MustbesignbyProvider,licensenumberand

disciplinerequiredNassauCounty•  ProvidersareresponsibleforProgressReportevery6months•  Everyreportmusthavethetestingresultandtestingdate.•  MustbesignedProviderandReviewer,licensenumberanddiscipline

required

AllReportsmustbesubmittedtoLIEIServicesemail(LIEIServices@achievebeyondusa.com)OrFaxedwithattentiontoCaseManagementat631-385-7795Allreportswillberequestbyemail6weekspriortotheduedatebyLIEIServices@achievebeyondusa.comandagain4weekspriorbytheCaseManagementteam.DueDatesforProgressReportscanbefoundonyourServiceAgreement*****Allreportsmustbetyped*******

DischargeReports

•  ProvidersarerequiredtosubmitaDischargereportpriortotheIFSPendingwiththereasonfortheDischargeinservice.

•  MustbesignbyProvider,licensenumberanddisciplinerequired

Requiredforeachchildto

extendservicesforeachdiscipline

Iflate,IFSPreviewswillNOTbeapprovedandservicescanbe

lost.

ReportsmustbesubmittedontimetoyourCaseManager/

Coordinator

Dueevery3monthsfromthedateoftheinitialIFSP(Suffolk

County).Dueevery6monthsfromthedate

oftheinitialIFSP(NassauCounty)

DuedatesarelocatedontheAchieveBeyondServiceAgreement

EarlyInterventionBilling&SessionNotes

Schedule&SessionNoteSubmission

SessionnotesaredueeveryotherWednesdays.(Refertobillingschedule)Notesmustarriveintheofficebytheendofdayonthecorrespondingduedate

W2PartTimeProviders:ONLYoriginalsto:AchieveBeyondLIBillingDepartment225BroadhollowRd-Suite402Melville,NY117471099Providers:Email:libilling@achievebeyondusa.comFax:631.385.7795

Standard: Session notes are completed by the assigned qualified personnel and contain all required information. Policy Description: •  Session notes also assist payers, parents, early

intervention providers and municipalities in assessing the extend to which services are helping the child/family to achieve goals contained in the IFSP.

•  Session notes must be completed by all qualified personnel (i.e. special educator, physical therapist, social worker, etc.) delivering the early intervention services authorized in a family’s IFSP for each service delivered.

Sessionnotesarewrittendocumentsdescribingthetherapysessionthatyouprovidedforachild.

YoursessionnotesareusedtobillNYS,Medicaid,orInsurancefortheservicesthatyouprovided.

Sessionnotesareofficialdocumentsthatarearchivedinthechild’sfile.

Parents/caregiversmustreviewthesessionnote,verifythatthewritteninformationonthedocumentistrue,andthensignthesessionnote.

Oncebilled,eachsessionnoteislinkedtotheprovidersNPInumber,andlicenseorcertification.

Parentsmustneverbeaskedtosignblanksessionnotes.

SessionnotesmustbelegibleandwritteninBlackink.

RealTimevs.ScheduleTime.

Time&Datemustalwaysbe

documentedaccordingtotheactualsessionprovided.

Parentsmustneverbeaskedtosignblanksession

notes.

Providers&Parentsmustsignsessionnote

attheendofthesessionprovided.

Donotusewhiteout.Ifyoumakeamistake

CROSSOUTthemistake,dateand

initialit.

SessionNoteRequirementsRealTimevs.ScheduleTime.Time&Datemustalwaysbedocumentedaccordingtotheactualsessionprovided.Example:Servicesstartedat3:08pm,mustbedocumentedas3:08pm.

Allfieldsmustbecompleted**Alwaysdoublecheckourpre-filledinformationtomakesureitiscorrect.

Alldatesshouldbethesame.Theexpectationtothisruleiswhentheparentsignsacancellationnotethedatewillbedifferent.

WriteinCPTcodesappropriately

CPTCodesWrittenforallsessionswhenservicesareprovided

Twocodesfora30-minutesession,threecodesfora45-minutesession,fourcodesfora60-minutesession,etc.

‘Persessioncodes’canbewrittenoncefor30-,45-,or60-minutesessions

Donotwriteacodefollowedby‘x2’,‘x3’,‘x4’,etc.

v TherapistmustfollowthemandatethechildisgivenintheIFSP.Forexample,iftheIFSPstates45minutesthe45minutesisspentservicingthechild.Sessionnotesmustnotbewrittenduringthistimeorspentonanyotheractivity.

Nassau County Session Note

Sample

NassauRecommendations“Recommendationforsupport,education,andguidance”isanareaonthesessionnotethatmustbecompletedforeachpagewheresessionsaresubmitted.

Alsoensureyousignafter“Icertifythatalltheinformationlistedaboveiscorrecttothebestofmyknowledge.”

Suffolk County Session Note

Sample

EMBEDDEDCOACHING

AbsentNotes-***MustbewrittenforallcancellationswhenmandateisnotfulfilledfortheweekortheIFSPfortotalsessions

DateofService

DateNoteWritten

Indicatethatsessionwascancelled

Reasonforcancellation

ProvidersignatureandLicense/Certificationnumber

CaregiverSignature

NassauCountyCancellationNoteSample

SuffolkCountyCancellationNoteSample

Errordetermined

Notifiedof

issueby

emailandp

roviderwil

l

contactPro

vider

Relationso

ftimetosto

p

byofficeto

correct

Note

resubmitte

dand

billingwill

process

v Correctionsnotbeinginitialedordatedv  Incorrectmake-updatev Wrongauthorizationnumber/IFSPperiodv  Incorrectdate(parentsignature,datenotewrittenorsessiondate)v  InvalidCPTcode(black)v Missinginformation(time,signature,date,location,credentials)

v IncorrectDates&Timesthatmayhavecausedan

Overlap

SameProviderOverlap

Determined.

ParentSurveywillbeconductedtoverifycorrecttime

anddate.

IfParentconfirmstimethen

correctionwillbeapproved.

IfParentdoesnotconfirm.Sessionnotewillbemark

asnon-billable.andInternal

investigationmaybeconductedforentirecaseload.

SameChilddifferentprovidersOverlap

Determined

Ifyourtimeiscorrect;requestwillneedtobemadefrom

otheragency/therapistto

voidsothatwecanre-bill.

Ifyourtimeisincorrect;

Parentsurveywillbe

conductedtoverifynewtime.

IfParentconfirmsnewtimewewill

rebill.

IfParentdoesnotconfirmdate/timewewillmarkthenoteasnon-billable.andInternal

investigationmaybeconductedforentirecaseload.

Ifyouuserealtimeasessionshouldneveroverlap

Make-Ups&AbsentNotesMake-Ups

Make-upscannotbecompletedonthesamedayoftheregularsession

Make-upsessionsmayneverbecombinedwitharegularsession,tobemadelonger

Make-upscanneverbedoneinadvance

AbsentNotesAnabsentnoteisneededforeverymissedsession.

Oneabsentnoteisneededforarangeofmissedsessions.

Absentnotesmustbesubmitted,togetherwithregularsessionnotes.

Make-upsessionsmaybeprovidedasclinicallyappropriate,agreeduponbytheparentsandinconformancewiththechildandfamily’sIFSP.

NassauCountyhas2weeksfromthedateofthecancelledsessiontoprovideamakeupandmustbewithinthesameIFSPperiodSuffolkCountyhasthewholeIFSPPeriodtocompleteMakeupsMake-upsareallowedforfamilyvacationsforSuffolkCountybutnotNassauCounty

SessionNotesandIncidentsofNon-Compliance

AchieveBeyondinvestigatesallpossibleincidentsofnon-compliance.Incidentsinvolvingbillingissuesareoftheupmostimportance.

Possibleincidentsofnon-compliancecanbediscoveredviainternalqualityassuranceactivity(fileaudits,parentsurveys,clinicalsupervision,etc)Orviaexternal/internalreports(parents,providers,SCs,EIOfficials,otheragencies/serviceproviders,officestaff,etc)

PossibleIncidentofNon-ComplianceWithRegardstoSessionNotes:•ParentreportsthatproviderhasnotbeenprovidingservicesaspertheIFSP,attendanceindicatesfullcompliancewithIFSP•Parentreportsthatproviderhasnotbeenshowinguptoprovideservices,attendancedoesnotindicateanyabsences•Parentreportsthatproviderhasnotbeenstayingthefulltimeduration,sessionnotesindicatethatthefulltimeisbeingprovided•Parentreportsthatparent/caregiverhasbeensigningorhassignedblankorincompletesessionnotes•Parentreportsthatproviderhasbeen“doublingup”sessionsandpresentingmultiplesessionnoteswithmissingordifferentdatesonthem•Parentreportsthattheyarepresentedwithsessionnoteswithafuturedate•Providerislateinthesubmissionofsessionnotes•Providerhaslargeamountorisconsistentlyoverlappingsessions

Investigations–TheGeneralProcessReportismadetotheComplianceOfficer,pointpersonfortheinvestigation.Sessionnotesand/orproviderattendanceischeckedagainsttheinformationinthecompliancereport.Parents/familiesontheprovider’scaseloadaresurveyedtocheckforpatternsofbehavior.Interview/conversationwithprovider,relevantstaffmembers,parents,and/oranyotherindividualswhomayhaveinformationregardingtheincident.

Investigations–PossibleOutcomesClaimswithintegrityissuesarerefundedtothepayor.ABmayseekreimbursementforthedirectserviceprovider.Providermayreceivecorrectiveactionviaadditionaltraining.Providermaybeterminatedfromcases.Ifthereisevidenceoffraud,reportwillbemadetopayor.

TipsforAvoidingIncidentsofNon-Compliance1.FollowtheRegulations,notworthittoeverdeviatefromtheregulations.2.Sessionnotesshouldbecompleteandcorrectwhenpresentedforsignature,NEVERinsertincorrectorblankdatesortime.3.Neverforgesignatures.4.Neveraskaparenttosignblanknotes.5.Neverdoubleupsessions.6.Submityournotesontime.7.Usecommonsense–onlysubmitbillingfortheactualdatesandtimesyouprovideservice.

AchieveBeyondEmail

Toensurethatweadheretoconfidentialityregulations,anye-mailmessagescontainingchildconfidentialinformationmustbesentonlyviaourprotectedAchieveBeyondE-mail.

Pleasechecke-mailscontinuouslyandrespondwithin24hours.Askproviderrelationsifyouneedinstructionstosetupemailonyourphone.

IfyouarehavingissueswithyourAchieveBeyonde-mail,pleasecontactyourProviderRelationsSpecialist.