By Holly Christopher

Stellar Therapy Services Advocacy Work

In 2016, Stellar Therapy alerted TN Legislators of the obstacles school districts were facing with TennCare regarding claims for school-based healthcare services.

After presenting to the Senate Health & Education Committees, Stellar Therapy was asked to participate on a Task Force with the Department of Education and TennCare.  This advocacy continues today and has resulted in simplification of the parental consent process and reductions in reporting requirements by the insurance companies. 

TennCare Eligible Services for School Nursing Billing

• Blood glucose monitoring and testing
• Tracheostomy care and suctioning
• Colostomy Care
• Catherization procedure
• 02 Saturation monitoring for pulmonary and/or cardiac disease
• Nebulizer treatment
• G-Tube feeding
• Medication Administration

School Nursing services are reimbursable by TennCare when:

• Included in an IEP, IHP, or IFSP
• Provided by a licensed healthcare provider
• Ordered by child’s community physician
• Student receiving the services has TennCare coverage
• Parent gives written consent 
• School district has a NP/PA/MD providing oversight and retrospective chart reviews

Do School Nurses have to do anything new or different?

There are just a couple of steps that will need to be added to your regular process.

STEP #1
Parental Consent Forms

• Parental Consent forms packet will need to be sent home with every student who is receiving an eligible nursing service for chronic healthcare needs. 
• Parent Consent Packet Includes:
  • Cover Letter explaining to parents what they are receiving and why they are being asked to complete it.
  • TennCare Consent to Access
  • TennCare Notice of Access – for parents to keep
  • HIPAA information – for parents to keep
• With the cover letter added, these forms will be specific to your district.  The cover letter should be put on school district letterhead with a Director’s or Supervisor’s signature.  Stellar can and will provide an electronic packet that can be printed front and back.

TennCare Parental Consent Forms:

This is a Stellar form and is for information only. This form does not give consent to bill services.

Ask parents to complete to the best of their ability.

Which students should receive the consent form?

• Distribute and collect these forms on ALL students that receive eligible regular nursing services with a health plan, i.e., IHP, IEP, or IFSP.
  • Students that only receive a PRN service do not need a consent.

STEP #2
Returning consent forms with required plan documents to Stellar

• School Nurse will send completed parental consent forms to Stellar as they are received. Stellar uses the information from the consent form to verify which students have active TennCare coverage. We ask that all returned consent forms be sent to Stellar whether the parent has indicated the student has Tenncare or not. 
• Signed parental consent forms should be returned to Stellar along with copies of:
  1. Student’s IHP, IFSP, or IEP with eligible nursing services listed
  2. Student’s physician order for the eligible nursing services 
• These forms should all be returned together to Stellar by fax or email:

Fax (877) 665-5586

Email: Nursing@stellartherapy.com

• Parental consent forms can also be completed online: https://www.schoolhealthform.com

School Nursing Medicaid Reimbursement Program Parental Consent Reminders

• Send parental consent forms home with students receiving regular nursing services that are or are being written into an IHP, IEP, or IFSP.
• Send IHP, IEP, or IFSP to Stellar with the signed parental consent forms.
• Send student’s physician order to Stellar with the signed parental consent forms.
• If or when a student has a name change, get a new consent with the updated name listed.
• Siblings cannot be listed on 1 consent form; a separate consent needs to be completed for each child.
• Use the student’s given name on the consent; please refrain from using nicknames on the form.
• If a student moves out of a school district and back into the school district, the student needs a NEW consent.
• Present consent paperwork annually to all students with an eligible health plan.

Parental Consent FAQ’s

Q. Parents do not always have a copy of the child’s TennCare card – is that okay?

A. This is fine. If the parent knows the child’s TennCare information, it can just be filled in. If they do not have that information, please ask that they fill in the child’s social security number.

Q. Parent is unsure if child has TennCare or not. 

A. When in doubt, have parent complete the form anyway – no billing will happen if the child does not actually have TennCare.

Q. Parent says child has regular insurance in addition to TennCare – do we need info from other insurance?

A. No – only need TennCare information – no other insurances will be billed.

CREDENTIALING FUN!

There will be some credentialing paperwork that needs to be completed by all school nurses. This packet only needs to be completed one time.  

Federal law requires a monthly background check of the “Exclusion Lists” for all healthcare providers who are billing Medicaid services. We will need your information so that we can perform these regular checks. Our contract with the school district requires us to maintain your information with the utmost security and confidentiality.

What is the Exclusion List?

The OIG’s LEIE (Exclusion List)  is where individuals and entities currently excluded from participation in Medicare, Medicaid, and all other Federal health care programs, can be found.  According to the OIG, exclusions are imposed for a number of reasons:

• Mandatory exclusions – conviction of Medicare or Medicaid fraud; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances; among others.
• Permissive exclusions – OIG has discretion to exclude individuals and entities on a number of grounds: misdemeanor convictions related to health care fraud; misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances; submission of false or fraudulent claims to a Federal health care program; among others.

The exclusion list is updated on a monthly basis, and if an individual or entity has been reinstated, they are removed from the list.

Important Legal Stuff

FERPA and HIPAA PRIVACY LAWS

Our contract with the School District covers both HIPAA and FERPA privacy laws and requires that we protect and maintain this data with the utmost security.

HIPAA COMPLIANCE

School Nurses will need to sign a HIPAA agreement with Stellar Therapy. All Stellar Therapy employees have on file a signed Business Associate/HIPAA Agreement for the means of sharing protected health information.

MEDICAID PROVIDER COMPLIANCE TRAININGS

School Nurses will need to complete some compliance training modules that are requirements of Medicaid/TennCare.  

Topics covered in these trainings:

• Fraud, Waste and Abuse
• HIPAA 
• Cultural Competency in the Workplace

Each topic takes about 20 minutes to complete.  School Nurses will receive the email with these training modules Stellar’s Credentialing Department. They will be completed online with results being returned to Stellar once they have been completed.

Important Billing Info

99211 – Office or other outpatient visits for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 

The billing codes for nursing services are one time per day per student – so if a student receives multiple services in one day, only one code will be submitted for reimbursement.