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Common Billing Issues for Schools Claiming Medicaid Reimbursement

Common Billing Issues for Schools Claiming Medicaid Reimbursement. Tony Boaz, Director Medicaid In The Schools (MITS). School-Based Services. Hearing Screens Occupational Therapy Personal Care Physical Therapy Speech Language Pathology Vision Screens Audiology (fall of 2008) ARMAC.

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Common Billing Issues for Schools Claiming Medicaid Reimbursement

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  1. Common Billing Issues for Schools Claiming Medicaid Reimbursement Tony Boaz, Director Medicaid In The Schools (MITS)

  2. School-Based Services Hearing Screens Occupational Therapy Personal Care Physical Therapy Speech Language Pathology Vision Screens Audiology (fall of 2008) ARMAC

  3. Documentation Requirements Individualized Education Program (IEP) for direct, related service(s) identifying the student need Consent to release identifiable information Medical/treatment related documentation and paperwork

  4. Prior to Billing Medicaid District must have an NPI number District must have certified or state licensed staff District must apply for a Medicaid provider number for each service Must report NPI number and assign taxonomy code(s) within the Medicaid system

  5. Billing Requirements Through EDS PES software Setup and training required EDS is contact Responsible for keying in all student data Responsible for billing for services Responsible for running Medicaid eligibility

  6. Billing Requirements for FFS Electronic Billing Program SEAs software (additional software add-on) Setup and training is required MITS is contact, Help Desk resource Electronic record, easily accessible Student demographic information present from SEAs Medicaid eligibility ran automatically Billing done on weekly schedule automatically

  7. Common Problems Parent refuses to allow district to bill for services (education needed re: Medicaid) Lack of licensed or certified district staff Billing errors: user and/or EDS system Lack of documentation Lack of training Lack of resources

  8. Recent Happenings to Cloud the Process of Billing CMS letters notifying districts that their NPI data and IRS data does not match Requiring all OT/PT/SLP therapists to have a Medicaid number, or a PIN number at the least Increased rates that have been discussed, but not implemented. Some providers have started charging the new rates. QSource replacing AFMC

  9. More Clouding Slow Federal legislative movement regarding the elimination of MAC programs (as well as other proposed cuts) State laws implicating schools and Medicaid

  10. Arkansas Legislative Requirements Underperforming – Act 1527 (2005) It is the purpose of this requirement to identify the districts in the state that are under utilizing Medicaid funds for related services. ARKids First Outreach – Act 882 (2005) It is the purpose of this requirement to establish a program to inform students and their parents or guardians about health care coverage under the ARKids First Program. Vision Screens – Act 1438 (2006) It is the purpose of this requirement to establish eye and vision screenings for students enrolled in pre-k, kindergarten, grade 1,2,4,6, and 8, as well as all transfer students.

  11. Contact Information http://arksped.k12.ar.us/sections/medicaid.html MITS Help Desk 866-280-8300, option 2 MITS Policy and Programming office 866-280-8300, option 2 501-835-2093 501-833-8412 (Fax) Medicaid In The Schools (MITS) 2402 Wildwood Suite 172 Sherwood, AR 72120

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