Section 7 AAC 105.230 - Requirements for provider records(a) A provider (1) shall maintain accurate financial, clinical, and other records necessary to support the services for which the provider requests payment;(2) shall ensure that the provider's staff, billing agent, or other entity responsible for the maintenance of the provider's financial, clinical, and other records meets the requirements of this section; and(3) may not submit a claim to the department for payment for services unless to be provider's records are kept and maintained in accordance with this section.(b) A provider's record must identify recipient information for each recipient including the (1) name of the recipient receiving treatment;(2) specific services provided;(3) extent of each service provided;(4) date on which each service was provided; and(5) individual who provided each service.(c) A provider's record must identify financial information for each recipient including (1) the charge for each service provided;(2) each payment source pursued;(3) the date and amount of all debit and credit billing actions for each date of service provided; and(4) the amounts billed and paid.(d) A provider shall maintain a clinical or therapeutic record in accordance with professional standards applicable to the provider, for each recipient. The clinical record must include (1) information that identifies the recipient's diagnosis;(2) information that identifies the medical need for each service;(3) identification of each service, prescription, supply, or plan of care prescribed by the provider;(4) identification of prescription drugs dispensed in accordance with 7 AAC 120.100 - 7 AAC 120.140;(5) start and stop times for time-based billing codes;(A) a provider may only bill for a unit of service if the actual direct service time spent is in excess of 50 percent of the time value of the procedure code billed;(B) direct service time associated with a particular procedure code shall be calculated in the aggregate by the direct service provider for each date of service when determining the appropriate number of units that may be billed;(C) a provider may not use pre-populated clinical notes or time-sheets to document actual start and stop times;(D) a provider may not bill for services without proper start and stop times documentation;(E) the use of documentation that does not specify both start and stop times will result in an overpayment;(F) the following table shall be used when billing for time-based billing codes under this section and identifies the appropriate number of units to bill using a 15-minute time-based code: Units | Number of Minutes of Direct Service Time |
1 | >= 8 minutes through 22 minutes |
2 | >= 23 minutes through 37 minutes |
3 | >= 38 minutes through 52 minutes |
4 | >= 53 minutes through 67 minutes |
5 | >= 68 minutes through 82 minutes |
6 | >= 83 minutes through 97 minutes |
7 | >= 98 minutes through 112 minutes |
8 | >= 113 minutes through 127 minutes |
The pattern remains the same for direct service times in excess of 2 hours. |
(G) the following services may be billed on the same day as any other residential or inpatient service not already contraindicated when the recipient is discharged from a residential or inpatient service and admitted into a 23-hour crisis observation and stabilization service, crisis residential and stabilization service, or residential or inpatient service on the same day: (i) 23-hour crisis observation and stabilization services;(ii) crisis residential and stabilization services;(iii) residential or inpatient services;(6) annotated case notes identifying each service or supply delivered; (A) the case notes must be dated and either signed or initialed by the individual who provided each service;(B) for electronic records, an electronic signature that complies with the requirements of AS 09.80 (Uniform Electronic Transactions Act) satisfies the signature requirement under this section; and(7) except for facilities identified in 7 AAC 12.990(26), all records maintained contemporaneously with the service provided; for purposes of this section, contemporaneous record keeping means documentation is done not later than 14 days after the service ends; a provider may not bill for services for which records were not kept contemporaneously as required under this section.(e) A provider shall retain a recipient's records described in (b) - (d) of this section for which services have been billed to the department for at least seven years from the date the service is provided. The duty of the provider set out in this subsection applies to a provider even if the provider's business is sold or transferred, or is no longer operating. If a provider ceases business, the provider shall notify the department how the department can access Medicaid recipient records in the future.(f) A provider who maintains all or part of the provider's records in an electronic format shall ensure that the data required to be maintained by this section is available and accessible under this chapter or if requested under 7 AAC 105.240(a). The electronic records include the use of an electronic visit verification system required under 7 AAC 125.070, 7 AAC 125.350, 7 AAC 127.053, and 7 AAC 130.285. A provider's electronic data storage system must (1) comply with P.L. 104-191(Health Insurance Portability and Accountability Act);(2) protect against unauthorized modification; and(3) identify the creator and date of initial data entry and any modification.(g) Nothing in this section prohibits the use of an electronic health record or electronic visit verification system that generates prepopulated demographic data.(h) A provider may not submit a claim to the department for a service if a provider does not maintain records in compliance with this chapter, including records that must be maintained contemporaneously under this section.(i) Documentation of start and stop times as set out in this section is not required for evaluation and management codes, but documentation must be maintained in accordance with professional guidance as adopted by reference in 7 AAC 160.900(a).(j) Any claim submitted for reimbursement for which the provider fails to maintain documentation required by this section is considered an overpayment and subject to recoupment under 7 AAC 105.260.Eff. 2/1/2010, Register 193; am 6/7/2018, Register 226, July 2018; am 2/6/2020, Register 233, April 2020; am 2/12/2021, Register 237, April 2021; am 1/1/2023, Register 244, January 2023; am 2/2/2024, Register 249, April 2024Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040