Scheduling Exceptions

Exceptions to scheduling format when you could not see a client for the required amount of sessions.

Ideally, we want to see all clients for the maximum amount of sessions per month. These scheduling exceptions should only be used if it is not feasible to see the client for the maximum amount of sessions for the month.

FOR CHILDREN:

Children are required to be seen a maximum of 3 times per month, however, scheduling concerns may arise where you might only be able to see the client 2 times per month. 2 times per month is the minimum amount a child can be seen where we will be reimbursed by Medicaid.

If you only see the client 1 time per month, Medicaid will not reimburse us for that session. It is advised that if you know you won't be able to see the client 2-3 times within the month that you do not have any sessions with that client for the month.

If you only have two sessions with the client and one session is on-site and one session is off-site you will do your monthly summary as you normally would.

Location

PRP Monthly Report Location (POS 49)

Service Code

H2018: PRP Monthly Report (Minor) POS 49

If you only have two session with the client and both sessions are off-site, you will have to set up your monthly summary differently using the codes below:

Location

DO NOT USE - PRP Monthly Report Location (POS 15)

Service Code

H2018: DO NOT USE - PRP Monthly Report (Minor) POS 15

FOR ADULTS:

Adults are required to be seen for a maximum of 6 times per month. However, if scheduling conflicts arise they can be seen for a minimum of 2 times per month. So they can be see anywhere from 2-6 times per month.

Just like with the children, Medicaid will not reimburse us if the client is only seen 1 time per month. If you know it won't be feasible to see the client 2-6 times for the month, do not have have any sessions with them for that month.

As long as one of your sessions with the client is on-site, you can set your monthly summary up just as your normally would.

Location