AR eTherapy Branded Header

Therapy eNews

May 2011.

Article

Calendar of Events


>> Qsource Training:

Medical Necessity &  

the Retrospective  

Therapy Review

  

Date:  

June 2, 2011

 

Time:  

1 - 3 p.m.

 

Location:  

Conway School District

Professional Development Room  

902 Hairston

Conway, AR 72034 

 

To register for this event,  

click here


Helpful Tips for Providers
Guidelines for Reconsideration Review

 

A reconsideration review is always an option in the event a therapy provider receives a denial notification. 

Calendar 2011


For either a medical necessity or utilization denial, the provider is allowed 35 calendar days from the date on the denial letter to submit additional information for reconsideration.

The request must include a copy of the denial letter and additional supporting documentation.


It is extremely important to remember that only ONE reconsideration review is allowed per denial; therefore, providers should ensure that ALL documentation available for reconsideration of the denial is submitted.

Reconsideration requests must be mailed to:

Qsource Arkansas

ATTN: Therapy Review

124 West Capitol Ave., Ste. 900

Little Rock, AR 72201

 

Medicaid Guideline Reminders
Medicaid Provider Manual

 

Occupational and Physical Therapy: When a -1.5 SD or greater is not indicated by a norm-referenced standardized test, a criterion-referenced test along with informed clinical opinion must be included to support the medical necessity of services.  

 

Section II - 214.300 C-4 Arkansas Medicaid Provider Manual

 

Speech Therapy: When doing evaluations for Articulation, Phonological, Apraxia, Voice and Fluency a formal screening of language skills is required.  Examples include, but are not limited to the Fluharty-2, KLST-2, CELF-4 Screen or TTFC.

 

Section II-214.400 C-3h, 4i, 5h Arkansas Medicaid Provider Manual


Q & A about Medicaid Therapy

Question: Does a supervising therapist have to co-sign progress notes when therapy is completed by an assistant (COTA, PTA, SLPA)?


Yes: The qualified therapist or speech- 

language pathologist must review and  

approve all written documentation  

completed by the individual under his  

or her supervision prior to the filing of  

the claims submitted for the service  

provided.  

 

Each page of progress note entries must be signed by the supervising therapist with his or her full signature, credentials and date of review.

 

Section II-203.000 Arkansas Medicaid Provider Manual

 

 

Question: I am a private provider of therapy. How often do I need to obtain a referral for a client? 

 

Providers of therapy services are responsible for obtaining renewed PCP referrals every 6 months even if the prescription for therapy is for one year. A prescription for therapy services is valid for the length of time specified by the prescribing physician, up to one year.

 

Section II-204.000 and 214.000 B 1 & 2 Arkansas Medicaid Provider Manual



Question: Does the treatment plan have to be signed?

Yes: A treatment plan developed and signed by a provider who is credentialed and licensed in the prescribed therapy or by a physician.

 

Section II-214.000 F Arkansas Medicaid Provider Manual


Qsource-AR-420-2011-03