Frequently Asked Questions for submitting changes to prior authorization for THSteps-CCP PDN - RN/LVN hours:
When I request a prior authorization using the CCP prior authorization form do I have to request the RN or LVN hours in units?
No. Continue to request the RN and / or LVN hours the same as requested pre-HIPAA. You may ask for the hours by day, by week or by month. TMHP will calculate the hours requested and convert the authorized hours to units.
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If my RN to LVN ratio changes from the approved authorization what do I do?
If your hours vary from week to week that is OK. TMHP will provide the total number of hours allowed for the ENTIRE authorized period; therefore this will give the agency and family the flexibility to use the hours authorized as needed. Monitor the number of hours worked by each discipline, i.e. RN or LVN and make sure that it does not exceed the total number of authorized hours for the certification / authorized period. If the hours exceed the number of hours authorized for either discipline, the agency must submit a correction and receive confirmation prior to billing or within 10 days after the certification/authorization period is over.
Example: The authorized period for a particular patient was from 10-16-03 to 12-16-03 and the total number of units authorized for the period was T1002 RN = 1280 units and T1003 LVN = 1280 units. This is equivalent to 320 hours each for the RN and the LVN for the entire authorized period (that would break down into 40 hours a week for each) If during the authorized period, the LVN were to exceed the allotted 320 hours and the RN had not yet used any hours, the agency would need to submit a correction to the prior authorization request with the change noting the increased hours needed for the LVN and the decreased hours needed for the RN prior to billing or no later than 10 business days after the authorized period. This in NO way increases the TOTAL number of hours authorized; it merely changes the distribution of the hours from RN to LVN.
This will require some tracking on your billing office's part. Each week the agency's billing office will have to track how many hours have been used by each discipline in order not to exceed the number of hours prior authorized for each discipline.
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When I submit my RN to LVN ratio changes, does it need to be signed by the physician?
No. RN to LVN ratio changes to an approved authorization do not have to be signed. Simply submit the revision on a CCP prior authorization form with the revised hours per procedure code, affected dates of service and the current prior authorization number (PAN). Make sure that the cover sheet addresses the reason for the staff change.
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When I submit my correction, how will I know when the correction is approved and that I can bill for services rendered?
TMHP will respond to the correction within 10 business days letting you know that the hours have been amended. If you have not received a response to your submitted correction from TMHP within 10 business days, call the CCP prior authorization line. You will need a confirmation in order to bill.
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If I bill weekly, will my bills be rejected?
The total number of hours authorized for the entire authorized period will be given to providers and also entered into the TMHP computer. The only time the bill will reject is if you exceed the total number of hours approved for either discipline (procedure code). Therefore it is important for agencies to keep track of how many hours have been worked by each discipline and submit the correction as soon as possible prior to billing the hours for either discipline/procedure code.
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If I request all LVN hours, but have to work an RN for some of those hours or vise versa what do I need to do?
If you work an RN and are only authorized LVN hours the bill will be denied if submitted without an approved or corrected authorization. Although the agency may need to utilize a discipline other than what is authorized, the agency must make sure that a correction request is sent in and confirmed prior to billing.
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What is the purpose of placing the reason for the change on the cover sheet?
The purpose is to identify the type of request for routing purposes. This is not a justification or reason for the actual staff change; it is merely a tool to allow TMHP to route your request to the proper department. Suggested language for the cover sheet could be “Revision to procedure codes”.
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