Third Party Billing
Introduction
Julie Stoneking
Third Party Billing Coordinator
Brookside Education Center
Room 240
Part time
What is Third Party Billing?
Federal reimbursement to schools
for medically necessary services to
student with public & private health
insurance.
Billable Services are:
Speech, Occupational Therapy, Physical Therapy, Mental Health, Nursing, Personal Care, Special
Transportation, Assistive Technology, Oral Language Interpreter.
What is needed before we bill?
Parental consent
IEP/IIIP/IFSP
Daily Documentation
Supervision
Who will be supervising me?
Carol Bosma RN, LSN
ECSE, All Elementary, ALC
Lisa Dugger RN, LSN
Southwest, High School
Dr. Mary Larscheid, MSW,
PHD,LICSW
Para vs. PCA
A Para Educators roll is to be a PCA’s
Personal Care Attendants
PCA Responsibilities
Communicate effectively with the child
(speak the child’s language, sign, etc);
Communicate with the qualified
professional (report changes in child’s
condition to; contact with questions or
concerns);
Provide services according to care plan;
Respond appropriately to the child’s
needs;
Qualified PCA services are:
Activities of daily living (ADL's): The following
services and supports furnished to an individual, as needed, to assist in accomplishing activities of daily living including health and hygiene activities integral to the activity (e.g., cleaning up spills, laundering soiled clothing, and cleaning up toileting accidents):
PCA Services/Toileting, Grooming
Toileting
:
assistance with helping a child withbowel or bladder elimination and care including
diapering, transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies,
cleansing the perineal area, inspection of the skin, and adjusting clothing.
Grooming:
assistance with personal hygieneincluding basic hair care, oral care, shaving,
applying cosmetics and deodorant, and the care of eyeglasses and hearing aids (hearing aid checks are not covered). Nail care is included except for
PCA Services/Dressing, Bathing
Dressing:
assistance with choosing, applying orchanging clothing for the child, applying special appliances (orthotics and prosthetics) or clothing (TED hose).
Bathing:
assistance with basic personal hygieneand skin care for bathing or showering including transfers and positioning, using soap, rinsing, drying, skin inspections, and applying lotion.
PCA Services/Transfers, Mobility
Transferring:
assistance with moving a childfrom one seating/reclining area to another
(including, standing by to assist if needed, pivoting the person, two person assists and using a Hoyer lift).
Mobility:
assistance with ambulation includingusing a wheelchair and assisting a person with ambulation. Mobility does not include providing transportation.
PCA Services/Positioning
Positioning:
assistance with positioning orturning a child for necessary care and comfort
including relieving pressure areas, positioning using pillows, wedges or bolsters and repositioning
PCA Services/Health procedures
or task
Health related procedures and
tasks, including those listed below,
that do not require the skill of a nurse, are supervised by an RN, PHN, or LSN and can be assigned, under state law, by a health care
professional to be performed by a PCA. PCAs cannot complete sterile procedures or give injections.
PCA Services/Health procedures
or task
Provide ROM-range of motion and
passive exercise
to maintain a level of strength and muscle functioning.
Assist with self-administered
medication.
A PCA may remind the child to take his/her medication, hand the child his/her medication and/or assure the child has taken or administered the medication to him/herself. Self-administered medication means medication taken orally, by injection or insertion or applied topically without the need for assistance.PCA Services/Health procedures
or task
Observe, monitor and intervene for
seizure disorders
when the child has had a seizure within the last three months.
Tracheostomy suctioning and
ventilator care
Clean not sterile procedures Supervised by a nurse
Trained by a nurse, respiratory therapist or
PCA Services/Behaviors
Intervention and redirection for
behavior that is medically necessary
and related to the child’s disability.
Intervention and redirection for behaviors that fit into one or more of the three categories below:
PCA Services/Behaviors
Increased vulnerability due to
cognitive deficits or socially
inappropriate behavior (e.g. child
with a traumatic brain injury, a
syndrome that causes significant
mental disability);
PCA Services continued/Behaviors
Resisting care and verbal
aggression that cause care to take
longer than normally expected;
Physical aggression towards self or
PCA Services continued/Behaviors
Self-injurious behavior -causes injury to one’s
own body; examples: hitting, biting, head-banging, burning, poking or stabbing, ingesting foreign
substances or objects, pulling out hair, and suicide threats.
Physical injury to others - causes physical injury
or has the potential for causing physical injury to other people; examples: hitting, biting, pinching, scratching, kicking, stabbing, and pulling out hair.
Destruction of property -causes damage or has
the potential to cause damage to things; examples: breaking desks or chairs, tearing clothes, setting
PCA Forms
•
“Personal Care Services” form or
Plan of care
•
Daily PCA Log
•
LPN daily log (yellow)
Who completes the Forms?
Every Para/PCA working eligible
student receiving PCA services.
Teachers are not eligible providers
so they will never sign PCA log’s
Assistance needed examples:
Use as few words as possible. However you must include step by step how you help with the PCA task, How/if the student self helps(is it a verbal or physical assist or hand over hand), any triggers to watch for, how you intervene.
PCA Daily log.
•To be completed DAILY!
•To be signed & mailed to Brookside Monthly •Keep a photo copy for your records
09 04 08 Behavior Redirection #2 js 1 320
Julie Stoneking/PCA Julie Stoneking/pca Toileting ROM js js 1 1 js js js js js
What staff needs to know:
PCA Forms available via e-mail or supervisor Daily PCA logs. Make your own copies monthly
(use back to back copies)
Save a copy of “Personal Care Services” form for yourself and place in your para sub file
Have daily logs & a copy of “Personal Care
Services” form available when supervision visits are made. Supervisors need to look at them. Expect Supervision
within the first 7 days,
every 90 days for the first year and every
120 days after the first year.
Interschool mail daily documentation logs last day of each month.
Department of Human Services
NO-NO’S in documentation!!!
Because PCA logs are medical documents:
No Pencil
No Red ink
No White Out
No Ditto Marks “”
No arrows
No filling out forms weekly or
monthly
What to expect.
Supervisors will meet with PCA for 7
day supervision.
The special ed. teachers will have:
PCA log’s
Plan of Care
Transportation logs
Nursing logs
How do we communicate?
E-mail, so check your e-mail
often
Call me with ANY questions
Julie Stoneking
Brookside room 240
379-4840)w
