June's tip of the month for Successful Medicaid Claiming

As school budgets are being finalized there is one thing in common from district to district – how to determine how much Medicaid revenue a district can expect next year.

The key to successful claiming is making sure you follow all rules and regulations and you are indeed submitting all claims for reimbursement. If you follow CompuClaim's plan you will be sure to see your revenue increase. This is a team effort and if no one is monitoring these guidelines your district revenue will be affected.

In October 2010 the Connecticut SBCH program changed from bundled rate to fee for service. Districts were no longer receiving payments for bundled services, they now had the task of submitting claims for every service provided by qualified providers. This is known as
fee for service and what it means is exactly what you think, every service that a student receives that is part of their IEP program by a related service provider can be submitted for reimbursement.

One key to successful Medicaid claiming it to make sure your district is aware of all qualified “medically necessary services”? These services are part of our Connecticut State plan derived from a matrix based on Massachusetts guidelines that were approved by CMS. With guidance from CMS, the State developed a plan that was introduced to our districts.The problem is that many were and still are not aware of these services and have not fully reached out to ensure that all services were actually being submitted therefore revenue was affected.

Is your district submitting billing for the following qualified and eligible services?

• Counseling services

• Speech services

• Occupational Therapy

• Physical Therapy

• Nursing services including medication administration, health assessments

• Evaluations and Assessments to determine eligibility for related services

• Audiological Evaluations by an Audiologist or Hearing Instrument specialist, Assistive technology Assessments, Vision screenings by an Optometrist

Make sure that all services are indicated in a student's IEP and that staff log these services. District Medicaid staff should be monitoring these services at minimum on a monthly basis and should make sure staff submit these logs at the end of each month.

How does a district ensure that all services are being logged?

Make sure your Medicaid staff are checking to view service logs and that they inform Administration if providers fail to log services. The biggest mistake a district makes is to wait until the end of the school year to check on services. Accountability of providers is key to a district's successful Medicaid claiming and this is one of the biggest areas that a district fails to adhere to. If your staff falls behind in claiming so will your revenue potential. Make sure you inform your providers of the importance of timely submissions. Once these rules are established and good practices are followed revenue reimbursement increases and the district will see substantial growth in their revenue potential.

Don’t forget that documentation of all submissions is your responsibility –this will
be requested as you can be sure the State will not just hand you a check without validating your claiming.

Check back soon for our latest posts and tips to Maximize your Medicaid reimbursement revenue.