Network and Organizational Provider Documentation, Auditing, Compliance and Beneficiary Protection Training Post-Test and Evaluation

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* 1. In order for services to be reimbursed through Medi-Cal, you as the Provider must prove that:

The client requested the services from the county.

That the client wanted the services.

That the services provided were medically necessary.

That the client benefitted from the services provided.

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* 2. Regarding medical necessity, the client must:

Show that they consented for the services.

Attend all of their authorized sessions.

Be responsive to physical health care treatment.

Have a significant impairment in an important area of life functioning.

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* 3. When documenting the services you are providing, it is important to:

Always use blue ink.

Use a specific phrase in each progress note, which will ensure that the service you provided is Medi-Cal reimbursable.

Make sure that you are also documenting the Medi-Cal reimbursable services that were provided to other family members.

Document the intervention that was utilized during the session.

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* 4. The interventions that you provide to your clients:

Must be expected to diminish the identified impairment.

Should only be documented if provided within your office setting.

Can include any activity as long as the client participated.

Should generally be clear in your progress notes, but do not necessarily need to be as long as you use clinical language.

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* 5. Regarding client assessments:

You are required as the provider to always complete a new assessment for every client that is referred to you for treatment.

You are required to always have an updated client assessment for your records.

You are not required to have a client assessment for your records, but they are helpful for guiding treatment.

You may not request a copy of an assessment, for treatment purposes, from the county without consent from the client.

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* 6. When completing a Treatment Plan for the client:

It is generally a good idea to include the client, but they do not need to participate in the development of the plan since you are the one directing the treatment.

You should not write overly-specific treatment plan goals. It is better to keep treatment goals more general in nature in case you decide to change them later on.

They are helpful for guiding treatment, but it is not a requirement to complete one for every client.

It is important to remember to indicate the interventions (i.e. individual therapy) that you will be performing with your client.

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* 7. Your progress notes should include:

Every detail of what happened during your session.

The intervention, in clinical terms, that you performed with your client.

The client’s signature if the session was for individual therapy.

Vague terms, in general, because the note could be used as evidence in court someday.

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* 8. When documenting the services you provide to your client:

It is always important to remember to directly link the service to a treatment goal written in the client’s Treatment Plan.

You can document on regular notebook paper if you want to.

It is not critical to relate the client’s presenting clinical symptoms to their mental health impairment if the client has no mental health impairment.

If the client requests that you not document a service that you provided to them, then it is okay to not document the service and still invoice the county for payment.

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* 9. Regarding your Service Authorization (if your services are pre-authorized):

It is okay to begin providing treatment without one since the county case manager is probably in the process of getting one to you.

You can go over the number of sessions authorized as long as there is still time left on your authorization.

It is the preferred way of requesting additional sessions for your client, but a phone call to request the services is actually preferred.

If you have questions regarding the authorization, you should contact the county case worker that wrote it for you.

N/A

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* 10. Which of the following are considered covered individuals under Placer County’s Compliance Plan?

All individuals who contract with Placer County.

All Placer County employees.

All individuals subcontracted with a person who contracts with Placer County.

All of the above.

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* 11. Which of the following are your responsibilities under Placer County’s Compliance Plan?

Report violations of the Code of Conduct, agency policies and procedures or laws and regulations.

Participate in all required training programs.

Understand Medi-Cal documentation and billing requirements.

Make a good faith effort to detect and prevent any wrongdoing in day-to-day activities before it happens.

All of the above.

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* 12. A threshold language is any language that a Medi-Cal beneficiary speaks in the county.

True

False

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* 13. The 3 parts to medical necessity are Documentation, Impairment, and Intervention.

True

False

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* 14. For purposes of reimbursement, a client must have a covered DSM IV or ICD-9 diagnosis.

True

False

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* 15. As long as you use a specific phrase in all of your progress notes, all of your progress notes will be reimbursable.

True

False

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* 16. Current Placer County policy states that client assessments must be completed every 3 years.

True

False

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* 17. As long as you are directing the client’s treatment, it is not necessary for the client to sign their treatment plan.

True

False

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* 18. The client’s treatment plan should indicate all of the interventions (i.e. individual therapy, rehabilitation, etc.) that you are performing with your client.

True

False

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* 19. Progress notes should be very detailed, outlining everything that happened during the session.

True

False

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* 20. Using the phrase, “I supported the client…” is a perfectly adequate intervention for the purposes of documentation.

True

False

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* 21. All services in a progress note should directly link to a treatment goal written in the client’s treatment plan.

True

False

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* 22. If your client presents with significant substance abuse issues and you treat those substance abuse issues, this is fine as it means the client is dually diagnosed.

True

False