HealthCheck Training
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e-mail us at healthcheck@ncemch.org
Post-Test
Overview
Health Supervision
- Introduction
- Health History
- Physical Examination
- Screening Services
- Laboratory Tests
- Immunizations
- Health Education
Special Health Issues
- Introduction
- Mental Health
- Introduction
- The Provider's Role
- Ages and Stages
- Infancy
- Introduction
- Surveillance
- Screening Tools
- Developmental Checklist
- Bright Futures Approach
- Office Practices
- Early Childhood
- Introduction
- Suviellance
- Screening Tools
- Developmental Checklist
- Bright Futures Approach
- Office Practices
- Middle Childhood
- Introduction
- Suviellance
- Screening Tools
- Developmental Checklis
- Bright Futures Approach
- Office Practices
- Adolescence
- Introduction
- Suviellance
- Screening Tools
- Developmental Checklist
- Bright Futures Approach
- Office Practices
- Referrals
- Documentation
- Autism Spectrum Disorders
- Introduction
- Screening
- Disorders
- Social Withdrawal
- Autistic Disorder
- Rett’s Disorder
- Childhood Disintegrative Disorder
- Asperger’s Disorder
- Pervasive Developmental Disorder
- Commonly Associated Disorders
- General Interventions
- Referrals
- Resources
- Early Intervention
- Substance Use and Abuse
- Introduction
- Substance Use, Abuse and Dependence
- Commonly Associated Problems
- General Interventions
- Referrals
- Resources
- Dental Health
- Overweight and Obesity
- HIV Guidelines
- Child Abuse & Neglect
- Transition
- Language Barriers
- TEFRA/Katie Beckett
Documentation
Go To Resources »
Documentation
Billing Procedures
DHCF
sets the reimbursement coverage and limitation policies
for DC's Medicaid program. Policies that govern Medicaid
allow for the payment of a variety of medical services.
The HealthCheck Medicaid Provider Billing Manual:
Types of Reimbursement
- Fee-for-service – the provider is paid a fee for each procedure performed and billed.
- Cost-based reimbursement ("per diem" or "encounter" rate) – based on the provider’s actual cost for rendering services to Medicaid member.
- Capitation reimbursement -- A MCO is paid a fixed amount each month for each recipient (per capita) who is enrolled in its organization.
Member and Billing Issues
- Exceptions
to Payment Provisions. Medicaid will not reimburse for services for Medicaid members
if non-Medicaid members are provided the same service free of
charge. The only exceptions
are services provided by agencies that receive federal funds
from:
- Title V Maternal and Child Health of the Social Security Act (i.e., public health clinics); or
- Part B or C of the Individuals with Disabilities Education Act (i.e., early intervention or special education health-related services).
- Patient’s
Inability to Pay. A provider cannot deny service to EPSDT members between ages 18
and 21 based solely on the recipient’s inability to pay
a Medicaid co-payment amount.
If the
recipient is unable to pay at the time services are rendered:
- The provider may bill the recipient for the unpaid charge.
- Cost sharing is allowed for prescription drugs ($1) and eye glasses ($2).
- There is no cost sharing for HealthCheck recipients under age 18 (DC Medicaid Program Transmittals No. 95-29 and 95-25).
- Charging Members for Administrative Services. Participating Medicaid providers are prohibited from charging for the completion of children’s health forms.
Note: A charge is defined as “cost sharing”.
