School Based Medicaid Claiming

A TRUSTED LEADER IN FFS AND MAC MEDICAID CLAIMING

CompuClaim works with school districts to manage the FFS program from start to finish. We have over 20 years of experience with school-based Medicaid.  We are well versed in all state and federal regulations that relate to special education. We offer customized training programs, full-service support, and proprietary technology to reduce workloads while making sure that your district is taking full advantage of the Medicaid reimbursement program. We worry about the details, so that you don’t have to.

FFS claiming process begins with a special education student's IEP. Under current law, "health-related" or "medically necessary" services specified (i.e. prescribed) in a student's IEP can be claimed.

To make a valid claim an effective FFS claiming program, a district must

  • Stay current on changes to the state Medicaid claiming process

  • Stay current on changes to the federal Medicaid claiming process

  • Stay current on changes to the state Medicaid plan's coverage

  • Document the IEP itself and the prescriptions for the services specified in it

  • Document reception of parental consent for the services to be claimed

  • Manage physician prescriptions where necessary

  • Maintain, as required, originals and copies of all forms and records

Once services are provided, a district must

  • Document that the services were provided

  • Calculate the cost of services provided and match them to the state rate cards

  • Verify that the student was eligible for Medicaid at the time of service delivery

  • Verify that the service was prescribed in the IEP

  • Match the service to the parental consent form on file

  • Verify that the service was tendered by a properly licensed and certified provider

  • Develop/build claims for eligible services

  • Submit claims to the state Medicaid agency

  • Track claims

  • Participate in audits as necessary

If any of the above components are not completed exactly as required, reimbursements can be denied or, even worse, audit findings may require repayment of reimbursement funds already received.

CompuClaim will work closely with your school districts to manage the FFS program from start to finish. We have over 20 years of experience with school-based Medicaid, and our team is well versed in all state and federal regulations that relate to special education and Medicaid.  

MEDICAID ADMINISTRATIVE CLAIMING (MAC)

School districts may claim reimbursement for the administrative costs of providing school-based Medicaid services such as outreach for enrollment purposes, and coordination and/or monitoring of medical care. The Administrative Outreach Program receives partial reimbursement for the administrative costs to identify and help students who are considered "at risk" for various health problems. The goal is to direct these students and their families to the proper resources for help. This program generates revenue by tracking the time spent on outreach activities by school personnel, and by factoring the district's expense for staff providing these services.

 

CompuClaim understands the MAC program, and we have the technology to manage RMTS and Time Survey methodologies. We work with our client districts to manage the MAC process from start to finish every quarter. We provide training and management services to simplify the MAC process and maximize participation, we stay up to date on MAC regulations at the state and federal level, and we make sure that your district isn’t missing any reimbursements.

The federal government has approved two time study methodologies for MAC. In most states, these two methodologies are referred to as either a time study or Random Moment Time Study (RMTS). 

Time Study

A time study is created each quarter and covers a five to ten day period. The development of a time study for MAC requires the creation of a log into which all eligible participants in a school district enter their activities for each day in 15-minute increments.

To run a successful SDAC program using time study methodology, the district must ensure that

  • All relevant staff members participate

  • All time studies meet state Medicaid standards

  • Each provider is properly trained to complete the time study

  • All employees understand the codes used for each 15-minute period, so they can accurately record their activities

  • Surveys are disseminated within the state-approved time period prior to the time study

  • Each participant completes the time study and returns it within the approved time frame

  • A randomly chosen representative sample of surveys is pulled for validation 

  • Amassing and calculating all 15-minute intervals properly, sometimes for thousands of employees

  • Error checking and correcting

  • Proper documentation and calculation of all financial expenses concerning the special education program

  • Using the proper algorithms to generate the claim

Random Moment Time Study (RMTS)

RMTS methodology selects a percentage of employees to account for their activities at a randomly selected moment in time. District administrators then can extrapolate how much employee time is spent on reimbursable activities. Medicaid reimburses districts based upon valid, statistically correct claims filed under this process.

The creation of a valid RMTS requires the following steps:

  • Compilation of employee data from all participating school districts in the sample universe

  • Creation of a sample pool

  • Random selection of employees from the sample pool

  • Pairing of the randomly selected employee with a randomly selected date and minute in time

  • Recording by selected employees of the activities they were engaged in at the selected time

  • Statistical analysis by a district administrator of all submitted responses

  • Calculation of an average percentage of time spent on reimbursable activities by service providers

  • Proper documentation and calculation of all financial expenses concerning the special education program

All school staff members that provide MAC-related activities may be selected for an RMTS, such as therapists, counselors, and administrators. Some types of employees, such as 100% federally funded employees, employees who do not perform MAC activities, bus drivers, custodians, and cafeteria workers may not participate in the program.

If performed incorrectly, any one step of either a time study or an RMTS could invalidate some or all of the time study, costing your district dearly in rejected claims or, even worse, leading to audit findings that necessitate the repayment of Medicaid funds received.

CompuClaim understands the MAC program, and we have the technology to manage RMTS and Time Study methodologies. We provide training and management services to simplify the MAC process and maximize participation, we stay up to date on MAC regulations at the state and federal level, and we make sure that your district isn’t missing any reimbursements.

 

WHY ARE WE DIFFERENT FROM ANY OTHER VENDOR?

    • CompuClaim provides the tools necessary  to take back the control and manage your own Medicaid billing

    • Our solution has proven to reduce current Medicaid Vendor cost by up to 70%

    • Increased Medicaid reimbursement through optimization feature – capturing on every possible  billing opportunity and enhancing revenue

    • Increase Program Compliance through integrated business rules

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