CBHS, IBSS, and MCO Billing for Washington Adult Family Homes
Getting authorized is the hard part. Getting paid every month afterwards is the part that quietly goes wrong.
I prepare the monthly billing for CBHS and IBSS clients in adult family homes: one billing sheet per client, per month, built from that month's actual records so the claim and the documentation agree.
This is billing for supportive supervision specifically: CBHS and IBSS claims to your client's Apple Health managed care plan. It is the same thing most homes mean when they say MCO billing
What goes wrong with supportive supervision billing
Most billing problems in this program are not arithmetic. They are mismatches.
The claim says one thing and the daily log says another. A resident spent nine days in hospital and those days were still billed. The tier on the claim is not the tier on the authorization. The month was billed to the plan the client was on in January, not the one they moved to in March.
Any of these can bounce a claim, and some of them are worse than a bounce. A claim that pays and then fails a later review is a repayment problem, not a paperwork problem.
What I do each month
• Build the billing sheet for each client from that month's records
• Account for days the client was not served: hospital stays, absences, discharge, or a move
• Apply the correct tier for the authorization actually in force
• Prepare it in the format the payer expects
• Check the claim against the documentation behind it before it goes anywhere
How this works with the state clearinghouse
Washington has a clearinghouse that submits CBHS and IBSS claims for adult family homes. It is a good service and you should use it.
What it does is move your claim. What it does not do is build the case behind the claim: the application, the tier justification, the daily records, or the billing sheet itself. That is my part.
So this is not an either or. I prepare accurate billing from your documentation, the clearinghouse submits it, and because the two agree, fewer claims come back. If you are already working with them, nothing changes.
Which plans this covers
Apple Health managed care plans operating in Washington, including Molina Healthcare, Community Health Plan of Washington, Coordinated Care, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup).
Why an experienced RN, not a bookkeeper
Supportive supervision billing is not general medical billing. What makes a claim defensible is whether the clinical record underneath it supports the hours and the tier being claimed, and reading that record is nursing work.
A bookkeeper can enter what you tell them. They cannot look at a month of behavior notes and tell you the claim you are about to submit is not supported by them. I can, and I would rather tell you before it goes out than after a review.
Common questions
Do you submit the claims for us?
No. I prepare the billing sheet and check it against your documentation. Submission goes through the state clearinghouse or your own process.
Can you do this monthly on an ongoing basis?
Yes. Monthly billing is meant to be routine. Most homes send me the month's records and get the billing sheet back.
What if a client was in hospital for part of the month?
Tell me the dates and I account for them. Billing days a client was not served is one of the most common problems in this
program.
We bill for several residents. Can you handle all of them?
Yes, each one gets its own billing sheet for the month.
Do you also do the documentation the billing is based on?
Yes. Applications, daily supportive supervision logs, behavioral logs, activity calendars, and re-tiering requests. Billing is more accurate when the same person built the records.
What does it cost?
Contact me for pricing. Monthly billing is priced separately from application and documentation work.
Serving Adult Family Homes across Washington
King, Pierce, Snohomish, Clark, and Thurston counties, including Seattle, Kent, and Bothell. In-home, virtual, or telehealth.
Call (425) 415-7926 or email info@precisionassess.com.