Billing Guidance Units of Service Each procedure code has been assigned a service unit that is used for rate development and billing. Each service unit equals the amount of time that a provider must render the service in order to submit a claim to be paid for the service. 15 Minute Unit of The 15 minute unit of service will be comprised of 15 minutes of continuous or non-continuous service Service within the same calendar day. The full 15 minutes of service does not need to be provided consecutively, but must be rendered within the same calendar day in order to be billed. Day Unit of Service: The day service unit is defined in each actual service definition to which it relates. A provider must meet the requirements of the definition contained in the narrative in order to submit a claim for the rendered unit of service. A day is defined as a period of a minimum of 12 hours of non-continuous care rendered by a residential habilitation provider within a 24-hour period beginning at 12:00 a.m. and ending at 11:59 p.m. The exception to this rule, effective July 1, 2015, occurs when an individual is admitted to a hospital or nursing facility. When this occurs the residential habilitation provider may not bill for the day the individual is admitted regardless of how many hours of care the residential habilitation provider has rendered during the 24-hour period. When an individual is discharged from a hospital or nursing facility the residential habilitation provider may bill for the discharge day of service regardless of how many hours of care the residential habilitation provider has rendered during the 24-hour period. Hour Unit of Service The hour unit of service will be comprised of 60 minutes of continuous or non-continuous service within the same calendar day. This means the full 60 minutes of service does not need to be provided consecutively, but must be rendered within the same calendar day in order for a unit of service to be billed. Outcome-Based Unit A service unit that is outcome is tied to the actual cost of a purchased good. Per Mile Unit of Service Each unit of service equals one mile.
Billing Guidance Units of Service Each procedure code has been assigned a service unit that is used for rate development and billing. Each service unit equals the amount of time that a provider must render the service in order to submit a claim to be paid for the service. 15 Minute Unit of Service The 15 minute unit of service will be comprised of 15 minutes of continuous or non-continuous service within the same calendar day. The full 15 minutes of service does not need to be provided consecutively, but must be rendered within the same calendar day in order to be billed. Day Unit of Service: The day service unit is defined in each actual service definition to which it relates. A provider must meet the requirements of the definition contained in the narrative in order to submit a claim for the rendered unit of service. A day is defined as a period of a minimum of 12 hours of non-continuous care rendered by a residential habilitation provider within a 24-hour period beginning at 12:00 a.m. and ending at 11:59 p.m. The exception to this rule, effective July 1, 2015, occurs when an individual is admitted to a hospital or nursing facility. When this occurs the residential habilitation provider may not bill for the day the individual is admitted regardless of how many hours of care the residential habilitation provider has rendered during the 24-hour period. When an individual is discharged from a hospital or nursing facility the residential habilitation provider may bill for the discharge day of service regardless of how many hours of care the residential habilitation provider has rendered during the 24-hour period. Hour Unit of Service The hour unit of service will be comprised of 60 minutes of continuous or non-continuous service within the same calendar day. This means the full 60 minutes of service does not need to be provided consecutively, but must be rendered within the same calendar day in order for a unit of service to be billed. Outcome-Based Unit A service unit that is outcome is tied to the actual cost of a purchased good. Per Mile Unit of Service Each unit of service equals one mile.