Case Management Billing Guidelines DATE: 5/4/09 

Case Management (CM) units of service are designed to capture significant client-specific services. They may include face-to-face, phone and/or mail contact with the client, family member, school official, other service provider, or collateral contact in order to assess, plan, supervise and/or monitor a participant’s behavior, or link a participant with appropriate community resources. 

1. CM services must be documented in individual case files and the content of that documentation must support the length of time billed and appropriateness of activity.

2. One unit of CM is defined as one hour of direct client-specific service. Sub-units may also be billed in 15 minute increments at 1/4 the unit rate. As a rule, the CM provided must last a minimum of 15 minutes in order to be a billable service. If the CM service provided lasts less than 15 minutes (i.e., confirming an appointment, rescheduling an appointment), then it is not billable unless several significant services are conducted the same day and combined to meet the minimum requirement of 15 minutes.

3. Telephone Calls are billable if they capture significant services and meet the minimum 15 minute time requirement. If multiple phone calls are completed within the same day for a specific client and each call is less than 15 minutes long, they can be combined and billed as CM if the total meets the minimum 15 minute time requirement. Documentation must support the services and length of time billed. Telephone calls that consist of leaving voice messages do not qualify as billable services, regardless of the number of phone calls made in one day. Listening to voicemails left by, or regarding clients, does not qualify as billable services, regardless of the number of messages received in one day.

4. Mailings are billable if the content of the mailing is client-specific and meets the minimum 15 minute time requirement. In other words, a mailing can be billed for if program staff writes a letter with content that applies only to a specific participant and then mails that letter out. Mailing out flyers, calendars, and other information that is intended for distribution to multiple participants is not billable as case management.

5. Research is only billable if it meets the 15 minute time requirement and is done with the purpose of fulfilling a specific client’s need. This research must be followed up with a letter mailed to the client, specifying how their needs are being met with the information provided. Research completed by staff for the purpose of distributing information to multiple participants is not billable because it is considered preparation for services. CSC units of service already have preparation time built into the unit cost. Therefore, billing for preparation time is not allowable.

6. Case Staffings are only billable as CM services if they are part of a larger system that includes members beyond the staff from the Provider agency. Internal Provider case staffings are not billable because the cost is already built into the CSC units of service as part of staff supervision.

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