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Below are listed those activities that are billable case/targeted case management activities when done by a case/targeted case manager or case management supervisor. Any activity undertaken by an employee who is not a case/targeted case manager or case manager supervisor is not a billable activity. A billing unit is defined as 15 minutes of billable activities.
The sections below include some examples of the billable and non-billable activities. This listing is not meant to be all inclusive.
A: Assessment/Social History/Reassessment
(Iowa Administrative Code 441- 90.5(1)a.)
Taking member history.
Gathering and reviewing information pertaining to the applicants history from any source, including obtaining and verifying diagnoses.
Completing Risk Assessments and the Case Management Comprehensive Assessment.
Completing program assessments (e.g. - for CMH and EW level of care; county service level assessments) in order to determine service needs.
Researching funding sources, including non-Medicaid sources for services needed prior to service plan implementation.
Dictating, writing, editing and updating the assessment/social history documents.
Dictating, writing, typing, and signing narrative entries to document assessment and social history activities.
Contacts to establish or verify initial Title XIX eligibility (e.g. calls to Income Maintenance Workers). Checking eligibility via ISIS or ELVS is not billable as this is not a person to person contact.
B: Care Planning
(Iowa Administrative Code 441- 90.5(1)b.)
Reviewing progress on previous goals.
Completing activities to request funding, from all sources, for services (including exceptions to policy).
Planning for development or revision of the consumers comprehensive service plan (e.g. scheduling the meeting with the consumer, determining who the consumer wants to attend, etc.).
Conducting the comprehensive service plan meeting.
Dictating, writing, typing, and signing of the comprehensive service plan document.
Dictating, writing, typing, and signing narrative entries to document care planning activities.
Completing forms (paper or electronic) that are required to ensure access to, or funding of, needed services. (e.g. - entering service plan and specific service information in ISIS).
Closing a case and associated activities completed prior to the date of closing (e.g. writing a discharge summary, identifying other services that will be needed after discharge, making referrals to other agencies or providers).
Joint treatment planning with the Iowa Plan contractor.
C: Referrals and Linkage:
(Iowa Administrative Code 441- 90.5(1)c.)
Scheduling appointments for consumers with other providers.
Dictating, writing, typing, and signing narrative entries to document referral activities.
Researching service options for an individual, including coordination with funders and providers, including completion of referral documents and related contacts.
Contacts to complete service arrangements (e.g. arranging transportation, etc.).
D: Monitoring and Follow-Up:
(Iowa Administrative Code 441- 90.5(1)d.)
Monitoring and follow up, to determine whether services are being furnished in accordance with the consumers care plan. This includes time spent reviewing service provider files.
Monitoring and follow up, to determine whether the services in the care plan are adequate to meet the needs of the individual.
Monitoring and follow up, to determine whether there are changes in the needs of status of the consumer.
Making necessary adjustments in the care plan and service arrangements with providers to address changes in needs or status of the individual.
Dictating, writing, typing, and signing case record entries to document the monitoring activities.
Completing forms or reports to ensure the health and safety of the consumer, including Incident Report review, processing, and follow-up.
Also see Iowa Administrative Code 441- 90.5(1)d. for rules on required contacts.
E. Examples of Non-Billable Activities:
Travel time.
Paid time off (vacation, sick leave, etc.).
Activities provided by anyone other than a person who meets the qualifications to be a case/targeted case manager, even if they are working under the supervision of a case manager.
Unsuccessful attempts to contact the member or collaterals. (e.g. - a home visit when member is not at home or leaving a voice mail message for the member or collateral).
Services provided by more than one case manager to the same member at the same time.
Staff meetings, trainings and supervision.
Time spent in case review for Quality Assurance purposes.
Contacts with support staff within your agency.
Scheduling case managers appointments.
Bill submission and collection activities.
Checking Medicaid or service eligibility in ISIS or ELVS.
Calls to the ISIS helpdesk.
Filing.
Preparing and mailing NODs.
All pre-authorization activities required by the Iowa Plan contractor.
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Revised 4/1/11
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