D.C. Mun. Regs. tit. 22, r. 22-A2516

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-A2516 - HEALTH HOMES RECORDS AND DOCUMENTATION REQUIREMENTS

2516.1

Each Health Home shall utilize the Department's designated electronic health record for documenting and billing all Health Home services.

2516.2

Health Home providers shall maintain all Health Home consumer information in accordance with federal and District privacy laws and the Department's Privacy Manual.

2516.3

Health Home providers shall document each Health Home service and activity in the consumer's record in the Department's designated electronic health record. Any claim for services shall be supported by written documentation which clearly identifies the following:

(a) The specific service type rendered;

(b) The date, duration, and actual time, a.m. or p.m. for both the beginning and ending times, during which the services were rendered (there is no-predetermined expectation of time spent with each service this requirement is only to verify when the service began and when it ended);

(c) Name, title, and credentials of the person who provided the services;

(d) The setting in which the services were rendered;

(e) Confirmation that the services delivered are contained in the consumer's CCP;

(f) Identification of any further actions required for the consumer's well-being raised as a result of the service provided;

(g) A description of each encounter or service by the Health Home team member which is sufficient to document that the service was provided in accordance with this chapter; and

(h) Dated and authenticated entries, with their authors identified, which are legible and concise, including the printed name and the signature of the person rendering the service, diagnosis and clinical impression recorded in the terminology of the International Statistical Classification of Diseases and Related Health Problems - 10 (ICD-10 CM) or subsequent revisions, and the service provided.

2516.4

No Health Home provider shall be reimbursed for a claim for services that does not meet the requirements of this section or is not documented in accordance with this section.

2516.5

Health Home providers shall implement a compliance program that regularly reviews submitted claims and identifies errors and overpayments. Health Home providers shall repay any paid claims that do not meet reimbursement criteria within sixty (60) days of discovery.

D.C. Mun. Regs. tit. 22, r. 22-A2516

Final Rulemaking published at 63 DCR 849 (1/22/2016); amended by Final Rulemaking published at 66 DCR 5625 (5/3/2019)