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1、学海无涯 SECTION II OCCUPATIONAL PHYSICAL SPEECH THERAPY CONTENTS 200 000OCCUPATIONAL PHYSICAL SPEECH THERAPY SERVICES GENERAL INFORMATION 201 000Arkansas Medicaid Participation Requirements 201 100Group Providers of Therapy Services 201 110School Districts Education Service Cooperatives and Early Inter
2、vention Day Treatment or Adult Developmental Day Treatment 201 200Providers of Therapy Services in Arkansas and Bordering States 201 300Providers in States Not Bordering Arkansas 202 000Enrollment Criteria for Providers of Occupational Physical and Speech Therapy Services 202 100Occupational Therapy
3、 202 110Enrollment Criteria for a Qualified Occupational Therapist 202 120Enrollment Criteria for an Occupational Therapy Assistant 202 200Physical Therapy 202 210Enrollment Criteria for a Qualified Physical Therapist 202 220Enrollment Criteria for a Physical Therapy Assistant 202 300Speech Language
4、 Pathology 202 310Enrollment Criteria for a Speech Language Pathologist 202 320Enrollment Criteria for a Speech Language Pathology Assistant 202 330State Licensure Exemptions Under Arkansas Code 17 100 104 203 000Supervision 203 100Speech Language Pathologist Speech Therapist Supervision 204 000Requ
5、ired Documentation 204 100Electronic Signatures 205 000The Physician s Role in the Occupational Physical Speech Therapy Program 206 000The Role of the Occupational Therapist Physical Therapist and Speech Language Pathologist in the Child Health Services EPSDT Program 207 000Referral to First Connect
6、ions program pursuant to Part C of Individuals with Disabilities Education Act IDEA 208 000Coordination with Part B of the Individuals with Disabilities Education Act IDEA Amendments of 1997 209 000Third Party Liability 210 000PROGRAM COVERAGE 211 000Introduction 212 000Scope 213 000Exclusions 214 0
7、00Occupational Physical and Speech Therapy Services 214 100Utilization Review and Office of Medicaid Inspector General 214 200Guidelines for Review of Occupational Physical and Speech Therapy Services 214 210Retrospective Therapy Review Process 214 220Medical Necessity Review 214 230Utilization Revi
8、ew 214 240Denial Due Process 214 250Reconsideration Review 214 260Complaints 214 300Occupational and Physical Therapy Guidelines for Review 214 310Accepted Tests for Occupational Therapy 214 320Accepted Tests for Physical Therapy 214 400Speech Language Therapy Guidelines for Review 214 410Accepted T
9、ests for Speech Language Therapy 214 420Intelligence Quotient IQ Testing 215 000Augmentative Communication Device ACD Evaluation 215 100Augmentative Communication Device ACD Evaluation Benefit 学海无涯 216 000Therapy Benefits 216 100Extended Therapy Services 216 300Process for Requesting Extended Therap
10、y Services 216 305Documentation Requirements 216 310QIO Extended Therapy Services Review Process 216 315Administrative Reconsideration 220 000Recoupments 220 100Recoupment Process 230 000PRIOR AUTHORIZATION 231 000Prior Authorization Request Procedures for Augmentative Communication Device ACD Evalu
11、ation 231 100Reconsideration of Prior Authorization Determination 232 000Appealing an Adverse Action 250 000REIMBURSEMENT 251 000Method of Reimbursement 251 010Fee Schedules 252 000Rate Appeal Process 260 000BILLING PROCEDURES 261 000Introduction to Billing 262 000CMS 1500 Billing Procedures 262 100
12、Occupational Physical Speech Therapy Procedure Codes 262 120Augmentative Communication Device ACD Evaluation 262 200National Place of Service Codes 262 300Billing Instructions Paper Only 262 310Completion of the CMS 1500 Claim Form 262 400Special Billing Procedures 200 000OCCUPATIONAL PHYSICAL SPEEC
13、H THERAPY SERVICES GENERAL INFORMATION 201 000Arkansas Medicaid Participation Requirements 10 15 09 Individual and group providers of occupational therapy physical therapy and speech language pathology services must meet the Provider Participation and enrollment requirements contained within Section
14、 140 000 of this manual as well as the following criteria to be eligible to participate in the Arkansas Medicaid Program A A provider of therapy services must meet the enrollment criteria for the type of therapy to be provided as established and outlined in Section 202 000 of this manual B A provide
15、r of therapy services has the option of enrolling in the Title XVIII Medicare Program Item 1 C of the Contract To Participate In The Arkansas Medical Assistance Program Administered By The Division Of Medical Services Title XIX Medicaid further requires acceptance of assignment under Title XVIII Med
16、icare in order to receive payment under Title XIX Medicaid for any applicable deductible or coinsurance that may be due and payable under Title XIX Medicaid Services furnished to an individual enrolled under Medicare who is also eligible for Medicaid including Qualified Medicare Beneficiaries QMB may only be reimbursed on an assignment related basis When a beneficiary is dually eligible for Medicare and Medicaid providers must bill Medicare prior to billing Medicaid The beneficiary may not be bi
