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Beginning 8/1/22, Florida Medicaid is transitioning from using H codes for billing ABA services to using 9 codes. Read below for more information on recommendations on updating your codes in Rethink. *Rethink does not provide billing or coding training, but is offering this guide on system features that allow for updating your system to meet the new updates for Florida Medicaid.
Topic | Visual Support | Helpful Information |
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Step 1: Inactivating Billing Codes: | | Inactivating codes does NOT remove these codes from client authorizations nor does it prevent scheduling against clients with Active current authorizations with these codes. Inactivating the codes at the funder level prevents adding these codes to NEW authorizations moving forward.
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Step 2: Adding New Service Names, if needed: | | We recommend adding service names for the following services, if needed: Behavior Treatment under Concurrent Supervision, Protocol Modification under Concurrent Supervision, Group Service with 2 clients, Group Service with 3 clients, & so on through 6 clients and the same for Group Protocol Modification
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Step 3a: Adding New Billing Codes to the Funder: Under the relevant Fl Medicaid funder, Click the “+” sign to add billing codes On the popup, add your billing code, rounding rules & credentials Click ‘Save’
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Step 3c: Adding New Billing Codes to the Funder: Add 97155 and 97156 without a modifier(BCBA) and with the HN modifier(BCaBA) Also, add the option for the Telehealth modifier (GT) for 97156
| | Scheduling: |
Step 3c: Adding New Billing Codes to the Funder: Add 97153 XP and 97155 XP as separate services that do NOT require an authorization by checking the box at the top of the popup. Select a rendering provider Enter all other required fields and click ‘save’
| | 97153 XP (Behavior Treatment by protocol under concurrent supervision) This is a non-reimbursable code BUT must still be submitted to Medicaid 97155 XP (Behavior treatment with protocol modification under concurrent supervision) This is a non-reimbursable code for a Supervisee ONLY, BUT must still be submitted to Medicaid (Supervisor would use 97155 or 97155 HN for their overlapping time)
Adding these services separately as not requiring an authorization will allow these services to be scheduled without pulling from the clients' authorizations. If you are a Kareo user, please note that $0 rates will not upload to Kareo, so you will want to ensure that you have entered a rate of greater than $0 for each service on your funder set up in Rethink.
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Step 4: End dating authorizations for the inactive H Codes: | | |