Training explains CCS progress-note, billing and EHR procedures new providers must follow

Julie Winter, quality control and improvement coordinator for the Ashland Bayfield County CCS programs, led a training that summarized the documentation, billing and electronic-health-record procedures CCS providers must follow to receive county and Medicaid reimbursement.

Winter said providers must enter clinical progress notes for each instance of delivered support. She explained that Medicaid distinguishes billable time from necessary but non-billable activities and that documentation requirements come directly from ForwardHealth rules and the program’s progress-note rubric. “Providers do have a 15 day timeline,” Winter said, referring to the county requirement to enter billable notes within 15 days of service; in crises, she said staff must notify the team within 24 hours.

What to document: the progress note rubric requires a reason for meeting tied to the authorization, at least two observable data-based observations (not opinions) about the participant or setting, a reaction/response section describing progress made or lost and participant responses, and a plan that includes specifics about the next appointment and participant tasks. Winter stressed the state’s preference for direct quotes from participants when relevant because quotes are high-quality evidence for notes.

Echo EHR workflow and approvals: providers enter notes in the Echo electronic health record. Winter described the county workflow: providers save notes, facilitators and mental health professionals review them, and the facilitator sends an internal Echo message either approving the note for provider signature or requesting edits. A finalized (signed) note becomes part of the medical record and allows county billing staff to submit the service to Medicaid. Winter warned that once a note is signed and billed to Medicaid, it may not be reopenable and errors could trigger repayments if an audit finds non-compliant content.

Billable vs. non-billable and time rounding: Winter described billable categories (face-to-face or functionally equivalent telehealth, travel to appointment when delivering face-to-face services, and documentation time included in direct-service time) and non-billable activities (team coordination without the participant present, reminder calls/texts not tied to authorization, no-shows). She advised providers to capture non-bill notes when cancellations or no-shows occur so the county can document attempts to engage the participant. The training included a detailed explanation of rounding rules: direct-service time equals face-to-face/telehealth time plus documentation time; those totals are rounded to the nearest 15 minutes for Medicaid billing, with the minimal reported unit being 15 minutes.

Audit and correction process: Winter said providers are responsible for errors in finalized notes that lead to Medicaid recoupments; agencies are contractually responsible to repay improper claims. If an error is discovered before billing, the provider should email the service facilitator and program mental health professional to request reopening per the county’s progress-note correction policy; the facilitator will reopen the note if appropriate.

Examples and resources: the training included multiple worked examples of how to compute travel, direct-service and documentation time across in-person, telehealth and stacked-appointment scenarios, and pointed providers to a note-entry-and-monitoring process document, a rubric of required content, and sample notes available on the vendor/provider resources page.

Ending: Winter advised new providers to keep the documentation rubric and timing guidance at hand until they gain facility entering notes and stressed the program’s review steps to reduce audit risk.