Signature of the person providing the service (eSignature is allowed). A service note must be included for each continuous span of 15 minute units that describes how the service performed relates to the reason the service was authorized. Respite Code Service Unit Required Information for Record Other Required Billing Documentation W7247 Respite--In Home and out of One Documentation must include start and end No monthly progress note is Home Unlicensed– Basic; day time(s) in a 24 hour period (accommodate required. Levels 1, 2, 3; Participant multiple in and out to calculate more than 16 W7251 Directed Services (PDS); U4; hour requirement); and For each consecutive block of W7252 and Enhanced Signature of person providing the service units, documentation is required W7255 (eSignature is allowed), degree/title, and title for for substantive issues that impact W7256 Respite--Unlicensed Out of enhanced service levels only. the participant’s W7258 home Basic; Level 1 and 2; The provider must retain staff time sheets (including Health; W7264 PDS;U2; Level 2 Enhanced eSignatures or electronic time sheets) that Safety; Support and PDS; and U4 demonstrate the staffing ratio specified in the ISP. Preferences; W7266 PDS. Priorities; and W8000 Service Note Routine. Respite--In Home and out of 15 W8001 A service note must be included for each continuous home unlicensed– Basic; minutes W8002 span of 15 minute units (or each day unit) that Documentation needed upon levels 1, 2, and 3; PDS; U4; W8003 and Enhanced document caregiver relief. Notes should be written occurrence as required by Pa.
Signature of the person providing the service (eSignature is allowed). A service note must be included for each continuous span of 15 minute units that describes how the service performed relates to the reason the service was authorized. Respite Code Service Unit Required Information for Record Billing Other Required Documentation W7247 W7251 W7252 W7255 W7256 W7258 W7264 W7266 W8000 W8001 W8002 W8003 Respite--In Home and out of Home Unlicensed– Basic; Levels 1, 2, 3; Participant Directed Services (PDS); U4; and Enhanced Respite--Unlicensed Out of home Basic; Level 1 and 2; PDS;U2; Level 2 Enhanced Support and PDS; and U4 PDS. One day Documentation must include start and end time(s) in a 24 hour period (accommodate multiple in and out to calculate more than 16 hour requirement); and Signature of person providing the service (eSignature is allowed), degree/title, and title for enhanced service levels only. The provider must retain staff time sheets (including eSignatures or electronic time sheets) that demonstrate the staffing ratio specified in the ISP. Service Note A service note must be included for each continuous span of 15 minute units (or each day unit) that document caregiver relief. Notes should be written No monthly progress note is required. For each consecutive block of units, documentation is required for substantive issues that impact the participant’s Health; Safety; Preferences; Priorities; and Routine. Documentation needed upon occurrence as required by Pa. Respite--In Home and out of home unlicensed– Basic; levels 1, 2, and 3; PDS; U4; and Enhanced 15 minutes
Technical+Guidelines+3-27-17.docx