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DOC - Difficulty Of Care Payments

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Below demonstrates a basic placement service payment rate where there is an additional DOC rate.

Details

  • The rate is associated to two plans/contracts.
  • All care day services that use this rate will consolidate into one claim for the entire month.
  • The rate details say the following... "Effective 01/01/2007, for clients who are between the ages of 0 and 18, the contract agency and plan rates will be $17.00 per day consolidated into 1 month using the z1000 procedure code. This rate may also include a Difficulty of Care additional payment of $1.00 per point entered on the client's program modifier."
  • You would pay a facility for a client who is age 10 in the month of December and who has 5 DOC points at ($17.00 X 31) and ($5.00 X 31) for a total of $682.00.

DOC points are only entered with a client's Program Modifier.