Professional Learning Center

Medicaid Billing, Coding and Documentation

You may place your order using our new secure on-line credit card form or download a PDF form and fax or mail your order in today!

Do you feel that you need to learn more about Medicaid billing? Are you a prospective PROS provider?

If you answered yes to either of these questions then you should purchase our training series now! Our very popular Medicaid Billing series, now available on DVD or video tapes, covers important topics you should be aware of when billing Medicaid.

The series includes the basics of billing Medicaid, an overview of State and Federal Medicaid systems and regulatory compliance and proper Medicaid documenting and coding of behavioral health.

In light of recent OIG audits focusing on behavioral health services and federal initiatives to cut Medicaid spending, providers need to know what to do to minimize risks.

The novice biller as well as the experienced biller will find this series helpful and enlightening. (This series was taped during live training presentations.)

The three available courses are described below. Please fill out the attached order form and fax back with credit card information or return by US Post with your check.

Billing Medicaid 101 (approx 3 hrs)

Taped in April 2005

This session is intended for providers who have never billed Medicaid or individuals new to Medicaid billing.

Complying with the state's billing requirements for Medicaid can be a daunting task to the most experienced provider organizations. For those agencies new to the process, it can mean the difference between survival and its alternative. This 4 hour session will focus on the fiscal and operational tasks necessary to successfully operate a billing system that must interface with varied payment processes.

Medicaid Compliance: State AND Provider Responsibility (approx 4 hours)

Taped in April 2005

Beginning with an overview of state and federal Medicaid systems, we will discuss both the provider's and state's responsibilities regarding participation in the Medicaid program. The review will include the regulatory requirements as outlined in the Conditions of Participation for state facilities and providers who intend to participate in the Medicaid program.

Providers will learn how to protect themselves and their clients in circumstances of potential conflict by complying with state and federal guidelines.

This full-day presentation, will also review how an updated compliance, auditing and monitoring plan can help ensure that the services provided are appropriate and payable, and mitigate any potential enforcement by state or federal authorities.

Documenting and Coding Behavioral Health (approx 4 hours)

Taped in June 2005

Documentation and coding are inseparable. For many reasons, sufficient and timely documentation of all encounters and the directing treatment plans are both useful and required.

There is federal guidance for documenting most community behavioral health and substance abuse services; and in some instances NY State has added additional layers of requirements. We will review a range of acceptable methods of medical record documentation including minimum documentation guidelines, added state-specific requirements and what providers can do in circumstances where there is little guidance from either state or the feds.

Source documents in the Conditions of Participation are clear; The Code of Federal Requirements contains no specific, only general, documentation requirements. 42 C.F.R. 4245 requires (providers) to furnish "sufficient" information; BUT CMS's determination of "sufficient" generally relies on the charts cumulative documentation.

Using the context of "what auditors look for" and "what can we do to avoid audits", the presentation will suggest some bullet-proof documentation epistemologies for the participants' consideration.

Rules for dealing with multiple payers, crossover billing and conflicting requirements will be discussed. At the end of the day, the message about quality documentation will remain:

  • Good Documentation is Good Medicine.
  • Documentation is the basis for code selection.
  • Documentation is proof a service was rendered.
  • Good documentation is your best defense against malpractice claims.

About the presenter

Dr. Derek Jansen, brings 30 years of experience in community healthcare to Practice Management Associates, ranging from direct care provision to hospital and outpatient administration as the Clinical Director of Adult and Dual Diagnosis Services for a regional psychiatric hospital system.

Community Behavioral Health and others. He is a member of the American Association of Professional Coders, the Medical Billing Association of America, the Healthcare Financial Management Association and numerous others.

FQHC's, state Medicaid agencies, professional trade organizations, and regional hospital groups and individual practitioners regarding practice management, HIPAA contingencies, billing, coding and documentation compliance.

Dr. Jansen is author of "Guide to Documentation, Billing and Coding for Clinical Services in Behavior Health" published by NCCBH.