1/15/10 1 billing and reporting

04/13/23 1

Billing and Reporting

Title V MCH FEE, PHC, BCCC

Deborah Lewis, Program Specialist

04/13/23 2

Billing and Reporting

CHS Contract Management Home Page

• http://www.dshs.state.tx.us/chscontracts/ default.shtm

• Click on Forms

• All report forms are available

• Contractor Vouchers and Reporting

04/13/23 3

Title V MCH Fee for Service

• Accessing Procedures Manual

• Forms and Instructions

• Submitting Reports

• Report Approvals

• Common Questions

• Common Errors

• Contacts

04/13/23 4


Accessing Policy & Procedure Manual

http://www.dshs.state.tx.us/mch/fee/policy.shtm

Section 2 – Performance Management

Billing & Reporting

04/13/23 5


Forms and Instructions• Monthly

Reimbursement Request (MRR)

• Identifying information found on cover pages 1 & 2 of the contract

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Identifying Information – Example 1• Contract term runs September – August• Payee Name, Contractor Name, Address, and

Payee Vendor ID # must agree• Payee Vendor ID # is 14 digits• DSHS Funding is already completed on the

downloaded Excel File• Purchase order # is 10 characters

04/13/23 7


Identifying Information (continued)• DSHS Document # is 10 digits based on Tax ID and may have

an alpha character• Year – Attachment # is 4 digit year – 2 digit attachment #• As contract amendments are fully executed, a 1 up alpha

character will be added to the attachment #• Period cover by this report is MO/YR• Prepared By and Phone number should be completed on each

page• Processed by line should be left blank

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Review Components of 185

• Age group 1-21

• Watch for Case Management

• Watch for lab billing included with Prenatal visits

• Make sure billing is in accordance with Service Delivery Plans (SDP)

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Review Components of 186• Infants 0 – 11 months• Women over 21• Watch for Case

Management• Watch for lab billing

included with Prenatal visits

• Make sure billing is in accordance with Service Delivery Plans (SDP)

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Special Services Report (SSR)

• Billing for Genetic Services

• Page may be eliminated in FY 07

04/13/23 11


Review Monthly Activity Report (MAR)

• Counts start over in September for each service

• Each person should be counted one time per service per year

• Counts on the MAR should coincide with age group billing

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Submitting Monthly Reports • Table is in the Manual Section 2 Page 1• Due 30 days following the end of the month• MRR emailed to the Central Processing Unit

(CPU) at [email protected], or faxed to 512-458-7442

• MRR, 185, 186, SSR (if applicable), MAR faxed to 512-458-7235

• Please submit all pages simultaneously

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My Spreadsheet

• Shows report approval date

• Tracks all expenditures

• Monitors expenditure levels

• Monitors 185 & 186 for 25% spending on ages 1-21

• Tracks performance measures

04/13/23 14


Common QuestionsQ. Can co-pays be charged?A. Yes up to 25% of the reimbursable amount

Q. Can the 25% requirement be annualized?A. Yes the requirement is on a state wide basis

Q. Should co-pays for flu vaccine be reported as program incomeA. No co-pays for flu vaccine should not be reported as program

income because it is not a reimbursable expense

04/13/23 15


Common Errors

• Incorrect form submission

• Missing report pages

• Pages indicate different periods covered

• Identifying information incorrect

04/13/23 16


Common Errors (continued)

• Billing for labs inappropriately

• Billing for services outside the SDP

• Unduplicated client counts inconsistent with billing

• Counts not started over in September

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Making Corrections

• If the correction is requested, only submit affected pages

• If the correction is discovered, correct the next monthly billing

04/13/23 18


Payment Complications

• Purchase order adjustments for program code

• Purchase order adjustments for funding source

04/13/23 19


Annual DSHS Form GC-10 (270)

• PDF File • http://www.dshs.state.tx

.us/grants/forms.shtm• Revisions still need to be

addressed• This form should be used in

the interim

04/13/23 20


Instructions for the 270 Report

• In box 1b place X in the final box

• In box 4 enter Vendor ID

• In box 8 enter contract term

• In box 9 enter name and address

• In box 13 sign, date, type, or print name, title and phone number

04/13/23 21


Instructions for 270 (continued)• Total Reimbursable Services – after 2.5%

reduction not to exceed contract amount• Less Program Income (PI)• Expected Total Payment Amount• Total PI Available is the same as program income• PI Expended usually is the same as PI available• PI to be refunded is usually zero• Disregard the second page for cash on hand

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Annual Report Submission• Table is in the Manual Section 2 Page 2• Due no later than 90 days after the end of the

contract term• Original signatures required• Mail two separately to: DSHS

CPU mail code 1940 and CMB mail code 1914

1100 W. 49th St Austin, TX 78756

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Contacts• Deborah Lewis 512-458-7781 Program review

questions• Grisilda Porter 512-458-7111 ext 2940 Payment

status questions• Millicent Wilkins 512-458-7111 ext 2285 Vendor ID

questions• Gina Baber 512-458-7111ext 6445 Contract

Amendment questions• Travis Duke 512-458-7111 ext 3157 Policy

questions

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Questions & Answers

• Making the pieces fit

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Primary Health Care (PHC)





• Common Errors

• Contacts

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http://www.dshs.state.tx.us/phc/pandp.shtm

Section 2 – Performance Management

Billing & Reporting

04/13/23 27


CHS Contract Management Home Page• http://www.dshs.state.tx.us/chscontracts

/ default.shtm• Click on Forms• Click on Primary Health Care to access all

PHC forms • Click on Contractor Vouchers and

Reporting for report submission instructions

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Forms and Instructions

• Monthly Reimbursement Request (MRR)


• Approved budget found on attachment page 4

Contractor Name:Payee Name: Address: DSHS Funding: 0Address: Requisition/PO# 0City, ST, Zip: DSHS Document # 0Type of Entity: Year-Attachment # 0Payee Vendor ID No.: Telephone / Fax #: - -

TDH Funding:

$0.00

SALARIES $ - $ - $ - $ - FRINGE BENEFITS $ - $ - $ - $ - TRAVEL $ - $ - $ - $ - EQUIPMENT $ - $ - $ - $ - SUPPLIES $ - $ - $ - $ - CONTRACTUALS $ - $ - $ - $ - OTHER $ - $ - $ - $ - SUB-TOTAL $ - $ - $ - $ - INDIRECT $ - $ - $ - $ - TOTAL $ - $ - $ - $ -

($.00) ($.00)($.00) ($.00)($.00) ($.00)

$0.00

Prepared By: Telephone #:

Date:EF21-12004 9/2005

Requested Reimbursement for this Month =

Monthly Reimbursement Request for Primary Health Care or Population-based Services

0000

For contractor's services rendered in the performance of the DSHS contract attachment identified below:

August 20060

APPROVED BUDGET

CURRENT MONTH

BUDGET VARIANCE

For Internal Use Only - Date Received

ADVANCE REPAYMENT NON-TDH FUNDING

PROCESSED BY:

Information below to be entered by DSHS staff:

For Internal Use Only: Voucher#

Contract Term: 9/1/2005 - 8/31/2006

Period Covered by this Report (Mo/Yr):

CUMULATIVE

LESS: PROGRAM INCOME

00

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Identifying Information – Example 1

• Contract term runs September – August

• Payee Name, Contractor Name, Address, and Payee Vendor ID # must agree

• Payee Vendor ID # is 14 digits

• DSHS Funding should be CHS/PHC

• Purchase order # is 10 characters

04/13/23 30


Identifying Information (continued)• DSHS Document # is 10 digits based on Tax ID and may have

an alpha character• Year – Attachment # is 4 digit year – 2 digit attachment #• As contract amendments are fully executed, a 1 up alpha

character will be added to the attachment #• Period cover by this report is MO/YR• Prepared By and Phone number should be completed on each

page• Processed by line should be left blank

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Approved Budget – Example 2• Found in the contract attachment Section III

page 4 (usually the last page)• The total goes in the TDH Funding block above

the word Salaries• MRR amounts should match quarterly FSR

amounts• Budget variances must stay within the 10% budget

variance rule

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Contract Amendments Impact the MRR• Changes occur when contract is fully

executed• Attachment always changes with 1 up alpha

character• TDH Funding block changes if applicable• Approved Budget amount changes if

applicable

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Types of PHC Clients• Full Service – only eligible for PHC• Supplemental Service – eligible for PHC

but as a supplemental funding• Presumptive Eligibility – Presumed eligible

for PHC for up to 90 days (only used if there is an immediate medical need prior to the completion of the eligibility process)

04/13/23 34


Review Monthly PHC 200• Question 1 refers to

monthly eligibility screening

• Questions 2 & 3 refer to monthly enrollment & re-certification

• The sum of 2 + 3 should always be less than, or equal to the sum of 1b + 1C

Contractor: Phone: Address: Fax: E-mail: REPORT NUMBERS RELATING TO PRIMARY HEALTH CARE (PHC) PATIENTS ONLY 1. Total number of unduplicated individuals screened for eligibility this month.

The total of 1a through 1d should equal the total number of individuals assessed for eligibility stated in Question 1

1a. Number of unduplicated individuals screened potentially eligible for

another resource, but not eligible for PHC. 1b. Number of unduplicated individuals screened potentially eligible only

for PHC. 1c. _______ Number of unduplicated individuals screened potentially eligible for

PHC and another resource. 1d. _______ Number of unduplicated individuals screened and not eligible for any

resource. 2. Total number of unduplicated full-service PHC clients who newly enrolled in

and/ or were re-certified for PHC this month. The total of 2a and 2b should equal the total number of individuals enrolled in PHC stated in Question 2

2a. Number of clients enrolled new as full-service PHC Eligible. 2b. Number of clients re-certified as full-service PHC Eligible.

3. Total number of unduplicated supplemental service PHC clients who newly enrolled in and/ or were re-certified for PHC this month.

The total of 3a and 3b should equal the total number of individuals enrolled for supplemental services stated in question 3

3a. Number of clients enrolled as new supplemental PHC Eligible. 3b. Number of clients as re-certified supplemental PHC Eligible.

PHC-200 Monthly Reporting Form

Reporting Period (mo/yr): ______________________

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Review Monthly PHC 200 (continued)

• Question 4 refers to the number of PE’s on PHC during the month

• Question 5 is the unduplicated YTD count

• Question 6 is the number of visits each month

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Submitting Monthly Reports • Table is in the Manual Section 2 Page 1• Due 30 days following the end of the month• MRR emailed to the Central Processing Unit (CPU)

at [email protected], or faxed to 512-458-7442

• MRR and PHC 200 faxed to 512-458-7235 • Please submit all pages simultaneously • Only submit revised pages when corrections are

requested

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My Spreadsheet• Shows report approval date• Tracks all expenditures & quarterly

balances• Monitors expenditure levels• Tracks performance measures• Tracks quarterly & annual report

submission

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Common Errors on Monthly Reports

• Incorrect form submission

• Missing pages

• Identifying information incorrect

• Budget & TDH Funding incorrect

• Cumulative amounts incorrect

• 1b + 1c less than 2 + 3

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Common Errors on Monthly Reports (continued)

• Incomplete forms, or blanks

• Incorrect totals on PHC 200

• Decrease in Year-to-Date totals

• Counting clients not specified in the SDP

• Dates don’t coincide

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Making corrections

• If the correction is requested, only submit affected pages

• If the correction is discovered, correct the next monthly billing

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Quarterly PHC 301• List the YTD cost of

PHC services• List the YTD number

of services provided• Calculate the cost per

unit of Service (cost divided by number)

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Submitting the Quarterly PHC 301

• Table is in the Manual Section 2 page 2

• Due via fax to CMB at 512-458-7532

• Due Dec 31, Mar 31, June 30, & Sept 30

04/13/23 43


Common PHC 301 Errors

• YTD cost of services are not YTD

• Number of services should not be an unduplicated count

• Incorrect unit cost calculations

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Quarterly DSHS Form GC-4a (269a)

• Financial Status Report

• Excel file• http://www.dshs.state. tx

.us/grants/forms.shtm

• Revisions will be minimal

04/13/23 45


Instructions for the Quarterly FSR 269a• Complete Identifying information at the top• Approved budget should match the most current

fully executed contract• DSHS share should never exceed the contract

amount• Reimbursements should show the amount you

expect to receive for the quarter• Complete bottom portion, sign, and date

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Quarterly FSR 269a Report Submission• Table is in the Manual Section 2 page 2 • Due Dec 31, Mar 31, June 30, and Nov 30• Original signatures required• Mail two separately to: DSHS

CPU mail code 1940 and CMB mail code 1914

1100 W. 49th St Austin, TX 78756

04/13/23 47


Common Errors on the FSR 269a• Incomplete, or inaccurate Identifying Data• Incorrect approved budget• Expenditures and income don’t match the

MRR• DSHS share exceeds the contract amount• Reimbursements don’t include expected

amounts

04/13/23 48


Annual PHC 300 Tips• #1-#2 totals should tie

with question # 5 on the August PHC 200

• #3 totals for both race and ethnicity should each tie with #1-#2

• #4 totals should add to equal #1-#3

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Annual PHC 300 Tips (continued)• #5-#7 totals should all be the same and only

include individuals 18 and older• #8 subtotals for B should be the sum of B and A +

B should equal #1• #9 individuals may be counted for multiple

scenarios and the total should be no less than #1• #10 list the number of counties served even if not

on your SDP and the total clients should equal #1

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Annual PHC 300 Tips (continued)• #11individuals may be counted for multiple

scenarios and the total should be no less than #1• Narrative Progress Outcome A. Service Delivery Plan Outcome

B. FQHC Coordination C. Medicare Prescription Drug Card/Medicare Part D D. Program Narrative - Optional

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Submitting the Annual PHC 300

• Table is in the Manual Section 2 page 2

• Due via fax to CMB at 512-458-7532

• Due November 30

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Contacts• Deborah Lewis 512-458-7781 Program

review questions• Grisilda Porter 512-458-7111 ext 2940

Payment status questions• Millicent Wilkins 512-458-7111 ext 2285

Vendor ID questions• Gina Baber 512-458-7111ext 6445

Contract Amendment questions• Kim Roberts 512-458-7111 ext 2990

Policy questions

04/13/23 53


Questions & Answers


04/13/23 54

Breast & Cervical Cancer Control (BCCC)





• Common Questions

• Common Errors

• Contacts

04/13/23 55



http://www.dshs.state.tx.us/bcccs/contractonly.shtm - manual

Manual of Operations (MOO)

Standard IX page 29

04/13/23 56


Forms and Instructions

• Form #B-13, State of Texas Purchase Voucher

• http://www.dshs.state. tx.us/grants/forms.shtm


• July and August must be billed separately

TDH Form B-13

STATE OF TEXAS

PURCHASE VOUCHER Page of WP5.1 (9/93)

2. Agency No. 501

3. Agency Name TEXAS DEPARTMENT OF HEALTH

1. Archive reference number

5. Effective date

6. DOC date 05/16/96

7. Due date

8. Doc Agency 501

4. Current document number

9.Payee identification number

10. PDT

11. PCC

12. Requisition number

13. Document amount

15. GSC order number

14. Payee name/address

16. Lease number

17. AGENCY USE FUND BUDGET CAT. SERV DATE General or Program Activity Code

Ref Doc

SFX

M

TC

Index

PCA

AY

COBJ

AOBJ

Amount

R

APPN

Fund

NACUBO Sub-Fund

Grant

number

Grant

year/phase

Project number

Project phase

Contract number

Multipurpose code

18. SFX 001

Invoice number

Description

AGENCY USE

Ref Doc

SFX

M

TC

Index

PCA

AY

COBJ

AOBJ

Amount

R

APPN

Fund

NACUBO Sub-Fund

Grant

number

Grant

year/phase

Project number

Project phase

Contract number

Multipurpose code

18. SFX 002

Invoice number

Description

AGENCY USE

Ref Doc

SFX

M

TC

Index

PCA

AY

COBJ

AOBJ

Amount

R

APPN

Fund

NACUBO Sub-Fund

Grant

number

Grant

year/phase

Project number

Project phase

Contract number

Multipurpose code

18. SFX 003

Invoice number

Description

AGENCY USE

19. SER/DEL DATE

20. DESCRIPTION OF GOODS OR SERVICES

21. QUANTITY

22. UNIT PRICE

23. AMOUNT

24. Contact name

Phone (Area code and number)

25. Entered by

26. I approve this voucher for payment. The above goods or services correspond in every particular with the contract under which they were purchased. The invoice for the goods or services is correct. This payment complies with the General Appropriations Act. Approved sign here


Date

Fiscal Approved sign here


Date

04/13/23 57


Forms and Instructions (continued)• Enter the date the voucher is submitted in box 6• Enter the 14 digit payee identification # in box 9• Enter correct purchase order number in box 12• Make sure the Document amount in box 13 matches

the total reimbursement requested• Enter payee name and address in box 14• Enter the service delivery date in box 19

04/13/23 58


Forms and Instructions (continued)

Description of Goods or Services box 20• Include statement for reimbursement• Program is CHS/BC• Contract Term is 07/01/06 – 06/31/06• 10-11 character document #• Year and 2-3 character attachment• Program code is 274

04/13/23 59


Forms and Instructions (box 20 continued)

Include the following:• Clinical Services • Support Fees (up to 10% of clinical services)• Case management • Professional Education Travel

All of these must be itemized with amounts even if there is no billing

04/13/23 60



• Boxes 21 & 22 can be omitted for BCCC

• Put all 4 amounts & the total in box 23

• Put the contact name and phone # in box 24

• All remaining boxes should be left blank

• Please do not sign the approval box

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• BCCC Summary (Sum) Billing Form

• This form must be attached to the State of Texas Purchase Voucher (B-13)

04/13/23 62


Forms and Instructions (Sum form continued)• Enter contractor number• Enter billing month• Enter contractor name• Enter award amount• Enter CD client identification number• Enter CPT procedure code• Enter date of procedure• Enter billing amount from BCCC Budget Table found in

the contract Exhibit A

04/13/23 63


Submitting Monthly Reports• Due 30 days following the end of the month• B-13 & Sum form emailed to the Central

Processing Unit (CPU) at [email protected], or faxed to 512-458-7442

• B-13 & Sum form faxed to 512-458-7235 • Please submit all pages simultaneously • Only submit revised pages when corrections are

requested

04/13/23 64


Report Approvals• Review B-13 for completeness and accuracy• Review Sum detail for completeness and accuracy• Notify provider if mistakes are found and resolve

issues• Sign & copy voucher when approved • Enter data on spreadsheet• Take sign copy to the Central Processing Unit

04/13/23 65


Common Errors• Purchase order # not included in box 12• Incorrect purchase order number & other

identifying information• Dates incorrect• Itemized amounts omitted• Totals incorrect• Rates incorrect

04/13/23 66


Common QuestionsQ. Can you bill more than one month on the same billing?

A. Yes as long as service dates are clear.

Q. Can you bill a procedure at different rate than the BCCCS rate schedule?

A. No.

Q. Can you bill a CPT code that is not listed on the rate schedule?

A. No.

04/13/23 67


Common Questions (continued)

Q. How is the support fee calculated?

A. It is 10% of clinical services not including Case Management Fee for Service

Q. Can you bill the new budget for services provided in the previous year?

A. No.

04/13/23 68


Quarterly Matching Contribution Report

• Due Oct 31, Jan 31, Apr 30, and Jul 31

• Requirement $3 Federal to $1 State match

• Contracts report proposed match in funding application

04/13/23 69


Quarterly Matching Contribution Report Instructions

• Contractor name as it appears on contract

• Indicate current budget period

• Indicate reporting quarter

• Indicate the base award

• Indicate projected match

04/13/23 70


Quarterly Matching Contribution Report Instructions (continued)

If additional funding are received,• Indicate additional funding award• Indicate match for additional fundingIf additional funding is not received.• Indicate N/A in for additional funding &

match

04/13/23 71



• Indicate Total Award• Indicate Total Match• Indicate the date the report was submitted• Indicate the name of the person submitting the

report• The name at the bottom must be the person who is

authorized to verify match information

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For each category (type of service) list the following:

• Detailed description of the service provided• Non-federal funding source• Quarterly amounts• Cumulative totals

04/13/23 73


Annual DSHS Form GC-10 (270)

• PDF File • http://www.dshs.state.

tx.us/grants/forms.shtm• Revisions still need to

be addressed• This form should be

used in the interim

04/13/23 74


Annual Report Submission• Due no later than 90 days after the end of

the contract term• Original signatures required• Mail two separately to: DSHS

CPU mail code 1940 and CMB mail code 1914 1100 W. 49th St Austin, TX 78756

04/13/23 75


Contacts• Vince Crawley 512-458-7111 ext 6467

Program review questions• Mitra Kookma 512-458-7111 ext 2085

Payment status questions• Millicent Wilkins 512-458-7111 ext 2285

Vendor ID questions• Gina Baber 512-458-7111ext 6445

Contract Amendment questions• Isa Covio 512-458-7111 ext 2792

Policy questions

04/13/23 76


Questions & Answers


1/15/10 1 billing and reporting

Documents

billing information

mrrtitle v mch fee

linkedtitle v mch fee

reportingtitle v mch

dshs stafftitle v mch

chs programstitle v

year attachment

dshs contract attachment