December 19, 2018
Behavioral Health Residential Facility (BHRF) and HCTC provider documentation and billing

Applicable to: Mercy Care RBHA
Mercy Care RBHA would like to provide some additional clarification on documentation requirements for BHRF and HCTC providers. BHRF/HCTC are 24 hour therapeutic living environments. As such, documentation of the member being present in the facility 24 hours per day is expected. 

Documentation during each shift (even while the member is sleeping) supports the per diem billing by noting the member’s presence in the facility. Documentation is expected during the entire 24 hour period. If the member is offsite on a pass, AWOL or inpatient, these instances should be documented for coordination of care purposes. If shift notes or other documentation is not present reflecting a 24 hour presence in the facility, the entire day of billing will be counted as an error on audits.  Please note that dates in which the member is AWOL, inpatient or otherwise absent overnight from the facility are not billable. The AHCCCS Covered Services Guide does note that room and board may be billed as a bed hold, but the residential service may not be billed on these dates .

Inpatient services do have a formal process and separate billing code for bed holds. This is not as formal for residential or HCTC. Please ensure that the process is appropriately followed when billing for any potential bed hold days.
In addition, start and stop times are required to be present on all documents including notes for therapeutic services occurring in the facility. This is helpful in determining the total time members are spending in therapeutic activities during the day and is important for coordination of care purposes. 
Documentation of services should be thorough including appropriate dates of service and staff signatures. Documentation is often found to be insufficient or illegible on review. Please ensure that documentation is thorough and accurately describes the behavioral health services provided and the member’s response to those services.

As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website .

Thanks for all you do!