Become a Medicaid All Star

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Clyde Little
5 years ago
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1 Florida School Finance Officers Association Fall Conference Become a Medicaid All Star Best Practices for Time Saving, Cost Effective and Audit Proof Medicaid Claiming

2 David Thomas Vice President of Business Development, Accelify David Thomas is nationally recognized as a leader in education reform. With over 24 years experience in education and strong political ties at the local, state, and federal level, David has been committed to ensuring equity and equal access to education is afforded to all throughout his career. David began his career as a classroom teacher and college professor and has held a number of leadership positions in education. In addition to serving as a local school board commissioner, David Co Chaired the Governor s Commission on Education Reform, and served as National Chair of the National School Boards Association, Council of Urban Boards of Education. David currently serves as a Senior Advisor to the Black Alliance for Educational Options (BAEO) and as Secretary of the BAEO Action Fund. Prior to joining Accelify, David spent nine years as Executive Vice President of Grade Results, Inc., a leading provider of online courses and content for virtual and blended learning models. In his role at Accelify, David oversees new business development for Accelify nationwide.

3 ACCELIFY BACKGROUND Accelify provides customer directed, enterprise level solutions and decision support tools aimed at driving operational efficiencies to help ensure schools deliver on their mission of educating ALL students Proven track record serving hundreds of local education and state agencies nationwide, including some of the largest districts in the country. On average Accelify clients see a more than 200% increase in Medicaid reimbursements while maintaining highest level of compliance. More than 20 years of operational experience in providing special education data management systems. 20 Years experience 1st AcceliTRACK selected as a finalist for SIIA CODiE Awards as Best K 12 Enterprise Solution the first Medicaid system recognized in this category.

4 AGENDA History of IDEA and Medicaid in Schools Federal Medicaid Guidelines Best Practices for Service Documentation Medicaid Claiming Process Revenue Maximization

5 History of IDEA and Medicaid in Schools

6 HISTORY OF IDEA Congress passed Title XIX of the Social Security Act which established a medical assistance program for individuals that meet income or disability guidelines Congress passes the Education for All Handicapped Children Act, P.L This was later renamed the Individuals with Disabilities Education Act (IDEA) The Amended section 1903 of Section 411 was added within the Medicaid Catastrophic Coverable Act, bringing Medicaid services to the school setting.

7 HISTORY OF IDEA Individuals with Disabilities Education Act (IDEA)., P.L Four Purposes: To assure that all children with disabilities have available to them a free and an appropriate education which emphasizes special education and related services designed to meet their unique needs; To assure that the rights of children with disabilities and their parents.are protected; To assist States and localities to provide for the education of all children with disabilities; To assess and assure the effectiveness of efforts to educate all children with disabilities. Federal IDEA Funding: While federal IDEA funding is supposed to cover 40% of average per pupil expenditure in the state, appropriations historically only cover 10%. of Funding For Pre K 12 Education/

HISTORY OF MEDICAID IN SCHOOLS Medicaid (42 CFR 440.

8 HISTORY OF MEDICAID IN SCHOOLS Medicaid (42 CFR ) Medicaid is a Federal/State funded health insurance program for low income and needy families/individuals Special eligibility considerations for children, pregnant women, disabled and elderly persons For persons under age 21, Medicaid may be known as EPSDT

9 Federal Medicaid Guidelines

10 FEDERAL MEDICAID GUIDELINES To qualify for billing services must meet Medicaid requirements to define the: Amount, duration, and scope of the service Medical necessity Prior authorization, which is typically covered by the IFSP/IEP

11 FEDERAL MEDICAID GUIDELINES Services must also be one of the covered service types which include: Physician and Nursing Services Mental Health Services Durable Medical Equipment Physical and Occupational Therapy Speech Therapy Transportation Services

FEDERAL MEDICAID GUIDELINES According to Medicaid (42 CFR 440.

12 FEDERAL MEDICAID GUIDELINES According to Medicaid (42 CFR ) required documentation for services must include: Date of service Student Name Provider name Service Duration Medical justification of service (diagnostic code) Group or individual setting Most states have additional service documentation requirements.

13 Best Practices for Service Documentation

14 Service Documentation Who should my providers document? The case for full IEP caseload documentation: Documentation is required for IDEA compliance. Providers do not require access to the Medicaid status of any student. District administrators gain greater transparency into IEP compliance. Electronic systems should have the ability to validate for eligibility, parental consent, and other factors, removing the requirement for providers to determine who should be billed and focus on quality documentation for all students.

15 Service Documentation Where should my providers document? The case for a web based system: Store service documentation in a single location Quick access to records in case of an audit Quick access to reporting on undocumented services and service delivery levels Fully protected service records in case of disaster

16 Service Documentation What are the most effective documentation review practices? Involve department leads Adhere to strict documentation deadlines Include documentation levels in performance reviews Use a web based system for easy access to reports on compliance levels for both providers and administrators

17 Service Documentation How can I incentivize my providers to document? Transparency on revenue generated and funding allocations Funding for conferences, professional development opportunities and equipment Contests for recognition and prizes Using a web based system that can replace redundant documentation and practices Integrated systems can build session notes into IEP progress notes for easy reporting

18 The Medicaid Claiming Process

19 MEDICAID CLAIMING PROCESS What Determines an Eligible Service? Services must pass a combination of factors to be billed to Medicaid: Student age Student Eligibility Valid IEP/IFSP on date of service Physical Therapy Prescriptions/Plans of Care (most states) Parental Consent to bill to Medicaid Service within the duration/unit of billing Group Size Provider Licensure/Certification

20 MEDICAID CLAIMING PROCESS How Often Should Eligibility be Submitted? Medicaid Eligibility is determined monthly and can often be retroactive. Monthly submissions for current status. Additional re running of eligibility files within timely filing limit.

21 MEDICAID CLAIMING PROCESS How often should services be submitted? The claiming process timeline varies by state. It is best to know the timely filing limit for your state to determine the frequency of submissions: Timely Filing for Initial Submissions (4 to 24 months) Return of Remittance Advice (1 week to 3 months) Timely Filing for Denied Claims (6 months to 24 months from date of denial) Highly recommended to submit monthly

22 Maximizing Medicaid Reimbursement

23 Maximizing Medicaid Reimbursement What are the largest potential barriers to receiving reimbursement? Eliminating Eligible Service Types: Service types that are difficult to document or bill like transportation or personal care are often left out of billing. Parental Consent: Consent that is either not collected or refused. OT/PT Prescriptions: Doctor prescriptions that are not collected or collected past the date of the IEP leading to a reduction in revenue. Missing IEP: Incomplete IEP data that prevent proper claiming. Over limit services: Services that are delivered over the duration or unit limit in the IEP and cannot be billed. Individual vs. Group: Proper specification of group or individual services in the IEP.

24 Maximizing Medicaid Reimbursement Best Practice for Documentation without Computer Access Transportation and Personal Care Services are often left out of the billing practices in many districts due to: Lack of computer access by bus drivers and personal care workers Limited time for documentation Questions to ask about billing transportation and personal care services: Is there a method of documentation that I can provide this personnel outside of a computer? How will this information be transferred to my billing system?

25 Maximizing Medicaid Reimbursement The Case for a Scannable Form Transportation:

26 Maximizing Medicaid Reimbursement Parental Consent Obtaining Parental Consent: The personnel who are charged with collecting parental consent should be trained annually on the best methods to clarify regulations to parents and/or guardians Provide parents and/or guardians with a parental consent form or FAQ to demonstrate a written assurance of their Medicaid rights: Image source: NYC Department of Education

27 Maximizing Medicaid Reimbursement Questions to ask about your parental consent practices: Is my district using a lifetime or annual form? Does my IEP system require parental consent to be collected at each IEP meeting? What options do my IEP teams have to track parental consent? If parental consent is refused or not collected, is there a follow up process? How are these efforts prioritized? How do I issue the annual notice of continued parental consent to ensure full distribution? How do I analyze the impact missing parental consent has on my revenue?

28 Maximizing Medicaid Reimbursement Questions to ask regarding prescriptions: Who collects my prescriptions? If there is a central collection protocol does this lead to delays in the receipt of prescriptions that impact billing? If prescriptions are collected by providers, what method does my district have to ensure this data is collected prior to claiming? How can I measure the impact of missing prescriptions on the Medicaid revenue my district receives?

29 Maximizing Medicaid Reimbursement When should I follow up: Monthly: Review Documentation for compliance levels and follow up with providers on missing documentation Submit claims to Medicaid Submit eligibility Review revenue exceptions from the previous month Quarterly: Review and resubmit Medicaid denials Review documentation levels against those called for in the IEP Follow up on parental consent denials and make a second attempt Annually: Train providers on best practices for documentation Train IEP teams on the best method to collect parental consent

30 So what does it all mean? There s no magic solution to Medicaid claiming Documentation is key! Medicaid maximization is a by product of proper documentation and addressing exceptions Your electronic billing system should make you feel confident that your program will withstand an audit

To learn more about Accelify visit our booth or find us online at www.accelify.

31 Become a Medicaid All Star Best Practices for Time Saving, Cost Effective and Audit Proof Medicaid Claiming Thank you. To learn more about Accelify visit our booth or find us online at and on social media. For additional information, contact: david.thomas@accelify.com linkedin.com/company/accelify llc

QUALITY ASSURANCE. Presented by Oakland Schools

QUALITY ASSURANCE. Presented by Oakland Schools QUALITY ASSURANCE Presented by Oakland Schools Quality Assurance Standards required by MDHHS 1) Covered services are medically necessary, as determined and documented through appropriate and objective