Cost Reconciliation and Settlement


As Medicaid spending rises quickly, controlling cost while coordinating care and improving quality is paramount. The Centers for Medicare and Medicaid Services (CMS) requires that states demonstrate that rates paid for school based services are no higher that the actual cost of providing these medical services.

With this new payment method cost reports must be prepared and completed by each LEA on a quarterly basis to reflect the time study results for the quarter in which costs were incurred. On an annual basis, each provider will certify through its cost report its total actual, incurred Medicaid allowable costs/expenditures, including the federal share and the nonfederal share. If costs exceed reimbursement received, LEA will receive a settlement but if costs are less than reimbursement received, LEA must payback the difference.

CompuClaim assists Local Education Agencies (LEAs) establish cost settlement and reconciliation procedures and supports schools through the billing process.

SERVICES INCLUDE BUT ARE NOT LIMITED TO:

  • Establishing cost based rate billing policies and procedures

  • Verify that the cost data submitted is allowable and allocable for reimbursement

  • Ensure the accuracy of the costs to be included in the rate determination

  • Provide Best Practices for reconciling cost

  • Help streamline the reconciliation process

  • Investigate discrepancies

  • Solve the inefficiencies of the cost reporting and cost settlement processes

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