8 Best Practices for School-Based Medicaid Billing

 

Is your school district leaving school-based Medicaid reimbursement funding on the table? What if you could maximize the reimbursements you receive for your Medicaid-eligible students, in both regular and special education?

When school districts provide healthcare and support services to eligible, Medicaid-enrolled students — like kids with cognitive or developmental delays, ADHD, or impairments in hearing, vision or speech — school-based Medicaid claiming and billing processes let schools recover a portion of the costs from State and Federal Medicaid programs. These services are organized through individualized education plans (IEPs), Individual Family Plans (IFSPs), or additional plans that vary by state. Depending on your state’s plan, additional services for Medicaid-eligible students might be reimbursable for those on chronic care, 504, behavior and speech improvement plans!

But with all the ins-and-outs of the program requirements and IEP processes, if schools aren’t aware of certain best practices, they might be leaving important funding behind — funding that could be furthering students’ education in additional ways.

At Go Solutions, we help schools ensure they get all the reimbursements from their Medicaid billing that they should. And you’ll see below, the key to getting these reimbursements most often involves timing. Here are the top eight best practices for school-based Medicaid billing that we like to share with our customers:

 

Be persistent about obtaining parental consent.

Parental consent to release a child’s education records, which contain information about the health-related services they receive, is the first step in getting the ball rolling for Medicaid reimbursements. A school can’t submit claims or receive reimbursement without it! But one thing we’ve learned is that although it is a one-time consent, best practices suggest that during the student’s annual IEP meeting, you revisit consent with parents who have previously refused it. Sometimes parents decline consent because they don’t have enough information regarding what consent really means. So the annual meeting presents an important opportunity to address what parental consent is, how it benefits both students and the district, and clear up any misconceptions the parent might have. Many schools tend to simply ask once and then don’t pursue it with the parent again. So, it’s wise continue to ask these parents about consent every year.

 

Add all students into your demographic database, since Medicaid eligibility and billable services fluctuate.

Make sure you add all students — not just current Medicaid-eligible students — to your student demographic database to verify continued Medicaid eligibility. Why? Because 1.) student Medicaid eligibility can fluctuate and 2.) additional state plan amendments can change which services are billable. In both situations, services are retroactive back to the effective date. But by including only the students who were eligible in the past, you may be missing out on new students or services that are eligible now. By including all students, it gives you the widest opportunity to maximize Medicaid reimbursement for the district.

 

Enter all services provided for all students, not just Medicaid-eligible ones.

We can’t emphasize enough how important it is to document every service provided for every student, not only for auditing purposes but for billing, too. What’s the old phrase: “If it’s not written up, it didn’t happen”? And while this documentation might take a little more time on the front end, it can save you a lot of auditing pain and reimbursement losses on the back end. Don’t forget to document services for non-Medicaid-eligible students as well as your verified, eligible students. A student can go in and out of eligibility, so by documenting everything, you’ll always have the information you need, when you need it.

 

Be on the lookout for lapsed IEPs to capture full reimbursements.

Each year, every special education student receives a new IEP, and each IEP has a service start and end date. To ensure your school district takes advantage of the maximum reimbursements, make sure there is no lapse between one IEP and the next one. Lapsed days between IEPs means lost reimbursement funding for your school.

 

Make sure referrals are processed on time.

Referrals are required for Medicaid services in all states but Arizona. And, depending on whether your state requires referrals to be sent out to physicians for signatures, this processing time can result in lapses in referral dates. These referrals are valid for a year from the date of signature, and not from the time they’re submitted. So, an untimely submission could translate to fewer service days that you can submit for reimbursement.

 

Ensure all your service providers are enrolled and licensed without lapse.

Lapses in licenses or enrollment in the Medicaid program can create all sorts of turmoil and delays for your documented provider services and the associated Medicaid billing. That’s why it’s important to make sure all of your school’s providers keep their licenses and enrollments up-to-date. A provider’s failure to recertify could potentially require them to go through the re-enrollment process, and that can cause even more delays and more lost reimbursements, ultimately disrupting and affecting the number of service days a school can bill for.

 

Make sure oversight approvals are done efficiently.

For providers that require mentor oversight — such as an occupational therapy assistant — any services they provide must be signed off on by their supervising mentor. Delays in sign-off by mentors can prevent the mentee’s services from being claimed in a timely fashion and that, in turn, delays reimbursements. You can help keep the ball rolling by identifying and monitoring missing service sign-offs. Once these claims are signed, you can then submit additional services, increasing reimbursements.

 

Drive transportation reimbursements with timely services documentation.

Schools can seek Medicaid reimbursement for Medicaid-eligible students’ transportation but only on days they receive a related service. For example, if a student has Occupational Therapy (OT), Physical Therapy (PT) or Speech two days a week, but the student is transported to school five days a week, you can only bill for two of those days.  When related service providers document timely Medicaid services, you can also bill for the associated transportation, increasing reimbursement potential and keeping your students’ records up-to-date.

 

Smart and streamlined Medicaid billing means more funding for your school!

By leveraging these eight best practices, your school district can see billable Medicaid services increase and watch your Medicaid reimbursements grow, right along with your students’ opportunities. And if you need support to help recover costs associated with the services you provide, or software to streamline the process even further, we at Go Solutions can help you there, too. Contact us today.

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