CCS training details strict progress‑note, billing and ECCO approval workflow

Ashland and Bayfield County staff used a recorded training to explain the counties’ expectations for progress notes, billing and the ECCO electronic health record workflow and why those procedures are important for Medicaid reimbursement.

Julie Winter, the counties’ quality control and improvement coordinator, told providers that ForwardHealth and DHS 36 require progress notes to document treatment goals and measurable progress. “If it doesn't include this, then it doesn't meet the requirements for reimbursing,” Winter said, noting that Medicaid can decline reimbursement when notes omit required clinical detail.

Nut graf: Providers must document the reason for meeting, objective observations, participant reactions and a concrete plan; notes are subject to county review and ForwardHealth/Medicaid audits. The counties route notes through ECCO (the counties’ EHR) and require service facilitators to review notes before a provider signs them.

What the note must include: Winter summarized the training program’s rubric. Every billable progress note must include: the reason for the meeting tied to the service authorization, at least two observations of the participant’s presentation (not opinion), progress gained or lost during the encounter, specific next steps (date/time and tasks), and selection of at least one relevant life‑area code. For telehealth encounters, the note must also describe the telehealth setting and identify who else was present.

Time, rounding and billing: The counties separate documentation time from direct service and travel time because Medicaid requires rounded billing units. Winter explained the county’s approach: documentation time is recorded as the actual minutes spent writing the note (not rounded); direct service time equals participant‑facing time plus documentation time and is then rounded to the nearest 15 minutes for billing; travel time is recorded and rounded separately. Winter walked through multiple examples showing how to total duration (direct service rounded + travel rounded = billed duration).

ECCO workflow and approvals: Providers complete a note in ECCO and save it, but must wait for an ECCO message from the service facilitator saying the note is approved “to sign.” Once the provider signs the note it is finalized and may be used for billing. Winter warned that finalized notes are locked and reopening them is possible only in limited circumstances and requires written notification to the service facilitator and the county mental health professional. She said reopening a note after submission to Medicaid may be impossible and could trigger an audit and potential recoupment; the training states contracted providers may be financially responsible if Medicaid seeks repayment.

Examples and redacted templates: The counties’ resource page contains redacted sample notes and a progress‑note rubric Winter encouraged providers to reuse while learning the workflow.

Ending: Winter urged providers to use the counties’ note templates, the note entry and monitoring process document and ECCO messages to assure timely approvals and to avoid audit risk.