Skilled Nursing Services

Skilled Nursing, and Screenings School-Based Medicaid Expansion Information

Skilled Nursing Services Guide from the UMASS and MassHealth

  • Description: Use this PowerPoint as your guide for the requirements to complete billing under the Expansion program. Please read the entire presentation and pay extra attention to the following slides:
    • To determine if services provided meet the definition of Medicaid Medical Necessity and Covered vs. Non-Covered Services: Slides 14-17, 27-33
      ***Services must require the clinical expertise of the practitioner
    • Types of Nursing Visits: Slide 15
      • Continuous Nursing: Nurse is at the side of the child continually; services is planned and pursuant to a care plan
      • Nursing visit- Student coming to the nurse for a procedure, assessment ect. May be planned or unplanned, may be pursuant to a care plan
    • What is included in Service Authorization: Slide 35-38
      *** Service Authorization cannot be ordered/signed by the school RN or LPN
    • What should be included in the Activity/Procedure Note on Service Documentation: Slide 42
    • Rule of Eights. To be billed skilled nursing services must occur for at least 8 minutes total to be counted as a billing unit. Always bill with the Start and End time of the visits and NEMB will calculate the time and units for billing. Slide 56
    • ICD-10 Diagnosis Codes: Slide 58

*** Important! All Service Authorizations/Doctors Orders, Care Plans, and District Orders must be kept securely for 7 years at the district in the case of an Audit.

Nurse Service Authorization and Service Authorization Guide

  • Description: See the Service Authorization Guide for all the required elements of Service Authorization. A doctor’s order can be used if it contains all the listed elements. If the doctor’s order does not contain all the elements for a billable student, please have the doctor adjust the order or have Nursing Service Authorization form completed fully.

 

Service Documentation Paper Billing Form

  • In-District Service Documentation Billing Form
    • Description: The In-District Service Documentation form can be used to document Medicaid Medically Necessity nursing services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Aspen, SNAP, or other nursing software. Yet, the form can be used as a guide to identify the procedure codes for your specialty. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis.
  • Out-of-District Day & Residential Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document Medicaid Medically Necessity nursing services that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.

Screenings

  • Description: The following screenings are typically given by a RN or LPN and meet the Medical Necessity requirement and require no Service Authorization, care plan, and are not subject to the 8-minute rule:
    • Hearing Screening
    • Vision Screening
    • Diabetes Screening
    • Dental Assessment
    • Lead Toxicity Screening
    • Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) Popularly used as part of Screening Brief Intervention and Treatment (SBIRIT)

*** See Slides 28-30 for all other billable screenings.

Screening Service Documentation Paper Billing Form

  • Screening Documentation Billing Form
    • Description: The In-District Service Documentation form can be used to document screening services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Aspen, SNAP, or other nursing software. Yet, the form can be used as a guide to identify the procedure codes for your specialty. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis.
    • *** Screenings use a TR modifier.
    • *** ICD-10 Codes for common Screenings:
      • Z01.10=Hearing Screening
      • Z01.0=Vision Screening
      • Z13.30= CRAFT/SBIRIT all Mental Behavioral Health Screenings
  • Out-of-District Day & Residential Screening Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document screenings that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.

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