NONBILLABLE MEDICAID ACTIVITIES

1
NON-BILLABLE MEDICAID ACTIVITIES

• Travel time.
• Attempted phone calls
• Attempted home visits.
• Attempted face-to-face contacts
• Record audits.
• Completion of any specially requested information
  regarding clients from the State office or from
  other agencies for administrative purposes (e.g.
  Disability, Social Security, etc.)
• Services provided to institutionalized Medicaid
  clients- (i.e. DJJ, jails/prisons, DMH Hospitals,
  ICF, ICF/MR facilities, IMD/s, long-term
  hospitalization outside of SC DMH, etc.)

2

• Recreation or socialization with a client.
• Professional judgment should be exercised in
• distinguishing between billable and non-billable
  
• activities.
• Documentation of service notes.
• Completion of Management Information System
• (MIS) reports and monthly statistical reports.
• Unstructured client time. Inactivity, free and
  unstructured time may be necessary for a client
  but is not part of a billable service.
• Educational services provided by the public
  school system such as homebound instruction,
  special education or defined educational courses
  (GED, Adult Development). Tutorial services in
  relation to a defined education course are
  non-billable.

3

• Educational interventions that do not include
  individual therapeutic process interactions.
• Filing and mailing of reports.
• Medicaid eligibility determinations and
  re-determination.
• Medicaid intake processing.
• Prior authorization for Medicaid services.
• Required Medicaid utilization review.
• Early and Periodic Diagnostic Screening and
  Treatment (EPDST) administration.
• Outreach activities in which an agency or a
  provider attempts to contact potential Medicaid
  recipients.

4

• Participation in job interviews.
• The on-site instruction of specific employment
  tasks.
• Staff supervision of actual employment services.
• Assisting the client in obtaining job placement.
• Assisting the client in filling out a job
  application.
• Assisting the client in performing the job or
  performing the job for the client.
• Drawing a clients blood, urine specimen, and/or
  taking the specimen to the lab.
• Visiting a client while in another mental health
• service program, unless for a special treatment
• activity. If this occurs, the time the client
  spends
• out of the mental health program should be
• backed out.

5

• Retrieving medications for the client kept at the
  
• CMHC, handing out prescriptions or medications.
• Scheduling appointments with the physician, or
• any other clinician at the CMHC.
• Providing non-authorized services to children
  placed in high or moderate management group
  homes.
• Staffing between clinicians in the same clinical
  unit within the mental health center for the
  purpose of supervision.
• Provision of direct services (e.g. medical,
  educational, or social) to Medicaid clients under
  Targeted Case Management.
• Out of home placement - regardless of the special
  needs of any one child, it is inappropriate for
  the out of home placement provider to rely on the
  outside provider to provide most or all of the
  treatment service to any child.
• Medicaid reimbursement is not available for
  respite care.