Time in the car
Accounting for time you spend in the car is tricky. Knowing some basic definitions will help:
Billable travel: This refers to time you spend alone in the car, in the process of providing a billable service. If you drive from the clinic to a client's house by yourself, then provide a billable service there, your driving time is billable travel. If you pick your client up and take them somewhere else to provide a billable service (like SSA), your driving time between the clinic and their home is still billable travel. Billable travel is accounted for as travel time (TT) on the billable note you write. Just remember, you must be alone to rack up billable travel minutes.
Transportation: This is time you spend going somewhere with your client in the car and not providing any billable services to them during that portion of the drive. In other words, when you're doing the same thing a taxi driver does, you're providing transportation. Transportation is never billable and must be accounted for with a non-billable code.
Non-billable travel: This is a catch-all category for "in car" time that can't be billed to Medi-Cal. Transportation falls into this category. Other examples are driving to and from your client's home when no billable service is provided, or driving places when your client is in the hospital. What all these have in common is, they must be accounted for under a non-billable code.
When your client is in the car with you: You have control over how the time will be documented. If you simply listen to the radio or engage in casual conversation, you're providing transportation. That needs to be broken out as non-billable travel (NBTT). If on the other hand you use the time to provide a therapeutic service (e.g., role-playing an interaction that's about to take place at SSA) you can convert NBTT into service time. If you provide a therapeutic service both ways, you can eliminate NBTT altogether.
Let's take a look at some real-life situations you're likely to encounter and see what they look like on paper:
Example 1 - Trip to SSA with transportation time:
Example 2 - Trip to SSA with counseling in the car:
In situations like this, the service you provide in the car must be the same type as you provide at your destination - otherwise you'll wind up with a blended note. Also, don't go overboard trying to turn every minute of driving time into billable service time. On longer trips you'll need to break some of it out as transportation.
Example 3 - Trip to SSA with in-car counseling and wait time:
When you go to places like Social Security or the DMV, there's almost always wait time and this is how you should break it out.
Example 4 - Trip to SSA with transportation and wait time:
In the above service, Note 2 would read something like this:
"Clt. is a 38 y/o single Hispanic male. I took member to SSA today to assist him in getting his benefits reinstated (see separate billable note). This note is to account for time T/W spent sitting with member in the waiting area at SSA and providing no billable services.
Note: Travel time divided between 2 services I did at this location."
Example 5 - Trip to SSA with client already at the program:
In the example above, if the PSC had done a rehab service on the way to and from SSA, service time would increase to 67 minutes while non-billable travel fell to zero. To help reviewers understand why there's no travel time of any kind, we'd add a footnote like this: "Note: There is no travel time on this note as I provided a billable service in the car."
When you account for transportation on a (-5) note, it goes under travel.
When you account for wait time on a (-5) note, it goes under service.
In transportation-only notes, you need to put 1 of the travel minutes in service & face-to-face time, since Caminar won’t accept a note with “0” service time.
When you have travel time, non-billable travel time, or no travel time on a billable note away from the clinic, use footnotes like the ones below to help reviewers understand what's going on:
TT=Driving alone between TAO and member's home.
NBTT=Transporting member from his home to SSA and back.
Note: There is no travel time on this note as I provided a billable service in the car.
Note: Travel time divided between 2 services I did at this location.
NFTF=Calling 911 while another PSC stayed with the member.
"NFTF" isn't related to travel, but since we're listing footnotes here I thought it should be included. NFTF (Non face-to-face time) is used at the bottom of billable notes when face-to-face and service times are different. It's a brief explanation of what you were doing when the member wasn't with you.