Is it Billable?
Voicemail or email with client or collateral
No
The Comprehensive Needs Assessment consists of these 3 dcoments
VA Comprehensive Assessment
Diagnosis Review
Medical Necessity Criteria (MNC).
The Initial ISP should be completed within what time frame?
24 hours
Timeline for when the Service Registration need to be submitted to the MCO
Within one business day of admission to the service
Format required for goals on an ISP
SMART - Specific, Measurable, Achievable, Relevant, Time-bound
A month where there were no client-related contacts or activities.
No
Adjustment Disorder is an eligible diagnosis to support Medical Necessity for MH Case Management Services.
No; the individual must have a diagnosis that meets Serious Mental Illness (SMI) criteria.
Timeframe for completiong of the Comprehensive ISP
Within 30 days of the assessment.
Minimum service time during a contact that is billable
None
However, BH Redesign may significantly change this requirement!
Necessary elements in a 90-day face-to-face visit include what?
A case manager writes their progress note on June 3rd for a service provided on May 28th.
No, billing must be entered in the record with 24 hours.
The assessment (CNA) directly drives the content on this documentation, outlining service needs.
The ISP
The required timeframe for review of the ISP
Every 90 days
The term describing the basis for compliant documentation that identifies the needs and progress made toward goals through the length of treatment
Golden Thread of Documentation
CM conducts collateral contact with another provider and documents, "Spoke with provider - client doing well." What quality elements are missing?
How does this relate to client's ISP and individual needs, lacks information about service coordination, what is the outcome/follow-up, etc.
MH Case Manager contacts client's family member to discuss client's transportation needs for an upcoming appointment but the client is not present and the family member is not a substitute decision maker.
Yes, if the collateral contact is directly related to the individual's ISP and care coordination.
NOTE: ROI is needed!
This document, at a minimum, is required to be completed if there is a 30-day lapse in services.
MNC
Name at least 2 case management activities.
During the quarterly review, the case manager determines that the client is no longer meeting case management needs. What should happen?
The case manager should document the reassessment and take appropriate action regarding continuation, modification, or termination of case management based on the individual's current needs.
The ISP expired on March 5th and it is now March 24th. What needs to be done to be able to bill?
Minimum service time during a contact that is billable
None
However, BH Redesign may significantly change this requirement!
Next steps when a FRAT score is >11
Add safety tier to ISP, reassess every 3 months until score is <11
The MHSS provider has reduced the frequency of services to the client because significant progress has been made. What does the case manager need to do?
Update the ISP as appropriate and discuss other ISP changes.
A client is in a local psychiatric inpatient program. What 2 elements are required in order for the CM to bill for services?
The client is within 30 days of discharge and services do not duplicate efforts of the facility discharge planner
Outreach attempts (phone call, home visit), risk of closure letter, DMAS right to appeal
Elements required before closing a client due to lack of engagement