Service, Documentation and Reimbursement Basics Flashcards
Medi-Cal Reimbursement Rules
Every claim has to be supported by a progress not and be present in the clinical record prior to submitting a claim for the service.
All service must be provided under an AMHD (Authorized Mental Health Discipline)
Services to be provided within scope of practice
Services provided after death can’t be claimed to Medi-Cal
time required for documentation and travel must be linked to the delivery of the reimbursable service;
travel time is reimbursable if travel was necessary for the provision of a service that the client couldn’t otherwise obtain because of mental illness.
Travel time between provider sites is not reimbursable.
transportation services are not reimbursable
What is an AMHD
Authorized Mental Health Discipline
What are examples of directing service by an AMHD
providing the service, acting as a clinical team leader, direct or functional supervision of service delivery, and approval of CCCP’s; the person providing direction does not physically have to be there.
When are services not reimbursable by Medi-Cal?
When provided in a jail or prison setting, clients 22-64 who are in an IMD, client under 21 residing in an IMD
services to kids in juvie are reimbursable…
when they have been adjudicated and are awaiting suitable placement.
clerical services are or are not reimbursable
NOT
supervision time is or is not reimbursable
NOT
Personal care services are or ar not reimbursable
NOT
Payee-related services are… reimbursable
NOT
How are Vocational, Educational, Recreational, and Socialization activities reimbursable?
If they involve systematic individualized feedback to specific targeted behaviors of the client; when these services are used to achieve an therapeutic goal, you can; interventions should be aimed at integrating into the community, enhancing inter-personal skills, accessing necessary resources.
translation services are
NOT billable
