The Medicaid Services Report feature is used to view reports of Medicaid billable services recorded through the entry of services records in programs of types beginning with the following:
- ACT Team
- ACT Service Team
- ACT Health Home
- CR
- Day Hab
- Medicaid Service
NOTE: Medicaid Service Reports can also be generated from within the BillingBuilder (in the Fiscal module) for users with the proper authority.
Required Permissions
Use of the Medicaid Services Report feature requires the following permissions:
Program Chart Access
Display Any Chart Records Buttons
Display Chart Records Services - Individual Button
Lock-In Medicaid Notes (only required if it is necessary for you to lock in those notes that should no longer be editable after the report is run)
NOTE: Permissions are assigned using the Permissions Maintenance feature. If you do not have access to that feature and need a permission listed here, please contact your supervisor or your local Help Desk for assistance.
Click-by-Click Instructions
Viewing a Medicaid Services Report
To view a read-only Medicaid Services Report, complete the following steps from the AWARDS Home screen:
TIP: The following instructions detail accessing the Medicaid Services from directly within the Utilization Reports feature. This report is also available in the AWARDS Reports module, where it can be bookmarked for easy access. For more information on using the Reports module, click here.
TIP: A CR Medicaid Loss Analysis report is also available from within the Reports module, and can be run for a selected month and year.
- Click the Program drop-down arrow in the upper-right corner of the page and select the program for which the report is to be viewed.
- Click Charts from the left-hand menu, and then click Services - Individual. The Individual Services fly-out menu is displayed.
- Click Utilization Reports, and then click Medicaid Services Report. The Monthly Medicaid Reimbursable Restorative Services Report selection page is displayed.
- Click the Month drop-down arrow and select the month for which the report is to be viewed.
- Click the Year drop-down arrow and select the year for which the report is be viewed.
- Click the Program drop-down arrow and select the program or group of programs for which the report is to be viewed.
NOTE: This feature is available to program types that begin with the following:
- ACT Team
- ACT Service Team
- ACT Health Home
- CR
- Day Hab
- Medicaid Service
NOTE: CR Supervised programs are not available in the Medicaid Services Report if they have greater than 100 residence units entered in the System Setup module's Agency Program Information feature.
- Click one of the show codes radio buttons to indicate the type of information to be included in the report:
Show Service Codes - When this option is selected, the report will include Medicaid billing loss analysis and summary information, a Medicaid Reimbursable Restorative Services Monthly Documentation Log containing identifying information, documentation requirements, billing information, and a list of clients lacking complete documentation.
Show Billing Codes - When this option is selected, the report will include Medicaid billing loss analysis and summary information, and a Medicaid Reimbursable Restorative Services Monthly Documentation Log containing status, resident name, billing dates, and codes information.
- If necessary, click the Click here to include only consumers who have complete services documentation checkbox if the report is to include only those clients for whom enough services have been entered for Medicaid billing.
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If necessary, click the Check here to include notes not selected by a supervisor checkbox if the report is to include information for all service plan linked notes,
regardless of whether or not those notes were selected for billing by a supervisor. - If necessary, click the Check Here to Lock-In Selected Notes checkbox if those notes currently selected for billing should no longer be editable after this report is run.
NOTE: This option is only available to users with the "Lock-In Medicaid Notes" permission assigned using the Permissions Maintenance feature. If you do not have access to the lock-in option and need a permission listed here, please contact your supervisor or your local Help Desk for assistance.
- Click CONTINUE. The Medicaid Services Report is displayed on the Medicaid Billing Loss Analysis page.
The contents of this read-only report are based on the detail setting(s) made on the previous page. It includes clients with a Medicaid Managed Care entitlement record, in addition to those with a Medicaid entitlement record.
The process of viewing a Medicaid Services Report is now complete.
Frequently Asked Questions
Medicaid Services Report Frequently Asked Questions
What are the Medicaid Service Report rules for ACT?
Half Month (aka Partial Month) billing for ACT requires two Face-to-Face contacts with the client on two different service days documented in Service Plan Linked Notes. No more than one of these contacts can take place in the hospital, and neither of the notes can be Collateral Contact notes. Each contact needs to have a duration of at least 15 minutes.
Full Month (aka Intensive Level) billing for ACT requires 6 Face-to-Face contacts documented in Service Plan Linked or Collateral Contact notes. Up to three of the contacts in a given month can be collateral notes. Two services can be provided on a single date of service only if one is with the client (documented in a Service Plan Linked Note) and the other is with collaterals (documented in a Collateral Contact Note). No more than two of he contacts can take place in the hospital. Each contact needs to have a duration of at least 15 minutes.
Hospital (aka Inpatient) can be billed if the client does not meet the requirements for Full or Half month billing. There must be at least two 15 minute contacts with the client, on different days documented in Service Plan Linked Notes.
All of the above listed rules apply to the Medicaid Service Report and to invoices generated for ACT services via the BillingBuilder.
What are the rules for Full Month and Half Month billing for CR residents on the Medicaid Services Report?
For Half Month billing, the client needs 11 days in residence out of the hospital, and two service plan linked notes. For Full Month billing, the client needs 21 days in residence out of the hospital, and four service plan linked notes. Additionally, the client must have a Medicaid entitlement and an Authorizing Provider in effect.
What determines whether a resident of a CR program is billed for the first or second half of the month if he/she was in the program for the full month?
A second-half bill is used when someone is in the residence only for the second-half of the month. They must be admitted after the 15th and have over 11 bed nights. It's not based on when services were rendered. So, even though a resident may have received two services in the second-half of the month, if he was admitted prior to the 15th of the month, he is still billed for the first-half of the month.
Where do the Medicaid numbers on the Medicaid Services Report come from?
The Medicaid Services Report pulls Medicaid numbers off of certified entitlement records. It will include Medicaid numbers that have since been closed out as long as the closure date is in the last 15 days.
Why don't all eligible notes show on the Medicaid Services Report?
Only two or four services will show on the report in accordance with Medicaid billing regulations for half and full month eligibility. In other words, because only two notes are needed for half month billing, only two will show if the client's days in residence are only going to permit half month billing. Similarly, because only four notes are needed for full month billing, only four will show on the report for full month billing, even if the client had more.
Why do some of a client's hospitalizations not display on the Medicaid Services Report?
Hospitalization records for which the type is set to "ER-Psych" or "ER-Med" are not counted on this report. AWARDS does not consider ER records to be reflective of a day out of the program.
Why does the Medicaid Services Report show "REF.PHYSIC.MISSING" when there is an authorizing physician in the client's record?
In order for the report to recognize the authorizing physician, the record for that physician in Support Services Contacts or Providers must have an "as of" date or "Start Date" (and "end" date if applicable) showing he/she was effective during the month for which the report was run. If no "as of"/"start" date exists, or if the "as of" and "end" dates indicate that the contact was not in effect for the client during the report's timeframe, AWARDS will not pull that authorizing physician into the report.
In general it is always important that "as of," "start" and "end" dates be maintained in a client's support services contacts and providers records, particularly in those used for billing.
Why does the Medicaid Services Report show some clients as being in residence for more days than are in the month, or for negative days?
When the number of days in residence appears to be incorrect, begin troubleshooting by checking the client's hospitalization records. Typically this type of problem results from there being multiple hospitalization records for the client without end dates on them. If the hospitalization records are cleaned up, the report information should be adjusted automatically.