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Nursing and Therapy
Services Handbook
Table of Contents
1. General Information NT-5
2. Certified Respiratory Care Practitioner (CRCP) Services NT-5
2.1 Enrollment NT-5
2.2 Services, Benefits, Limitations, and Prior Authorization NT-6
2.2.1 Prior Authorization NT-6
2.3 Documentation Requirements NT-6
2.4 Claims Filing and Reimbursement NT-6
2.4.1 Claims Information NT-6
2.4.2 Procedure Code NT-7
2.4.3 Reimbursement NT-7
3. Home Health Services For Nursing and Therapy NT-7
3.1 Enrollment NT-7
3.1.1 Change of Address/Telephone Number NT-8
3.1.2 Pending Agency Certification NT-8
3.2 Services, Benefits, Limitations, and Prior Authorization NT-9
3.2.1 Home Health Services NT-9
3.2.1.1 Client Evaluation NT-9
3.2.2 Benefits NT-9
3.2.3 Home Health Aide (HHA) Services NT-10
3.2.3.1 HHA Visits NT-11
3.2.3.2 Supervision of HHA NT-11
3.2.4 Home Health Skilled Nursing (SN) Services NT-12
3.2.4.1 SN Visits NT-12
3.2.5 Supplies Submitted with a POC NT-14
3.2.6 Medication Administration Limitations NT-15
3.2.7 Occupational Therapy (OT) Services NT-15
3.2.8 Physical Therapy (PT) Services NT-15
3.2.9 Prior Authorization NT-16
3.2.9.1 HHA and Home Health SN Services Prior Authorization Requirements NT-17
3.2.9.2 Canceling a Prior Authorization NT-19
3.2.9.3 Home Health SN Services and HHA Services That Will Not Be
Prior Authorized NT-19
3.2.9.4 OT and PT Prior Authorization Requirements NT-20
3.2.10 Limitations, Exclusions NT-21
3.3 Documentation Requirements NT-22
3.3.1 Written POC NT-22
3.3.1.1 Physician Supervision-POC NT-23
3.3.2 Home Health SN and Home Health Aide (HHA) Services NT-24
3.3.3 Home Health SN and HHA Services Assessments and Reassessments NT-24
3.4 Other/Special Provisions NT-24
3.4.1 Home Health SN and HHA Services Provider Responsibilities NT-24
3.4.2 Medicaid Relationship to Medicare NT-25
3.4.2.1 Possible Medicare Clients NT-25
3.4.2.2 Benefits for Medicare/Medicaid Clients NT-25
3.4.2.3 Medicare and Medicaid Prior Authorization NT-26
3.5 Claims Filing and Reimbursement NT-27
3.5.1 Claims Information NT-27
3.5.2 Reimbursement NT-27
3.5.3 Eligibility NT-28
3.5.3.1 Retroactive Eligibility NT-29
3.5.3.2 Prior Authorization of Retroactive Eligibility NT-29
3.5.4 Prohibition of Medicaid Payment to Home Health Agencies Based on Ownership NT-29
3.5.5 Claims Filing for OT Services NT-30
3.5.6 Claims Filing for PT Services NT-30
3.5.7 OT Limitations NT-30
3.5.8 PT Limitations NT-30
3.5.9 OT Procedure Codes NT-31
3.5.10 PT Procedure Codes NT-32
4. Personal Care Services (PCS) NT-33
5. Therapists, Independent Practitioners, and Physicians NT-33
5.1 Enrollment NT-33
5.2 Services, Benefits, Limitations, and Prior Authorization NT-33
5.2.1 OT Services NT-34
5.2.2 PT Services NT-35
5.2.3 ST and Aural Rehabilitation Services NT-36
5.2.4 Therapy in a Nursing Facility NT-37
5.2.5 Prior Authorization NT-37
5.2.6 Noncovered Services NT-38
5.2.7 Rehabilitative Services NT-38
5.3 Documentation Requirements NT-38
5.4 Claims Filing and Reimbursement NT-39
5.4.1 Claims Information NT-39
6. Private Duty Nursing NT-39
7. Claims Resources NT-39
8. Contact TMHP NT-40
9. Forms NT-40
NT.1 Home Health Services Plan of Care (POC) Instructions NT-41
NT.2 Home Health Services Plan of Care (POC) NT-42
NT.3 Home Health Services Prior Authorization Checklist NT-43
NT.4 Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form
Instructions (2 pages) NT-44
NT.5 Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form NT-46
10. Claim Form Examples NT-47
NT.6 Certified Respiratory Care Practitioner (CRCP) NT-48
NT.7 Home Health Services Skilled Nursing Visit NT-49
NT.8 Home Health Services Skilled Nursing Visit and Physical Therapy NT-50
NT.9 Physical Therapist NT-51
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