Whether it is shutdowns, learning interruptions, staffing shortages, or some other variant (no pun intended), it seems the punches from the COVID-19 pandemic keep on coming for school districts across the country. Each time we think we have established a new normal, another challenge emerges, forcing districts to adapt and implement operational changes quickly. With the possibility of more interruptions in the upcoming days and weeks, let us not forget what we have learned and share with others where we can to help us all continually adapt.
A Need for Visibility
If you do not know what your weekly service logging and claiming should be when times are stable, it is impossible to understand the impact of a new Covid related challenge. Be sure you have the systems and processes to track your weekly and monthly services to claims and claims to reimbursements conversions.
The following questions are a good starting point to think through:
- How many services do you provide each week during a stable period? What is the seasonality of those services?
- Has the service to claim conversion fluctuated, and if so, why?
- Are services not occurring, or are your providers delayed in their documentation?
- Are there particular types of services that drop more than others? (i.e., transportation and nursing vs. speech and OT?)
The COVID-19 interruptions have been one of the most significant disruptors of Medicaid services this decade. Whenever there is a disruption of your services, visibility is critical to determine what services are delivered and where you are in the claiming process.
Optimize and Automate Your Process
Use this time to get off paper!
While paper forms were once the norm, COVID-19 has shown us that keeping a record of your services is much more difficult through paper. Surprisingly in our Impact of Covid Medicaid study, we still saw 40% of schools using paper in part or whole. Not surprisingly, those who still used paper felt 2 times as likely to report staff feeling overwhelmed with their work. Paper can lead to many problems. This approach leaves several gaps in your billing management processes, such as:
- How are you ensuring that the forms contain the correct data needed for reimbursement?
- How do you monitor that a provider receives the forms within a timely manner?
- How are you ensuring that the appropriate office reviews your claims and processes your reimbursement?
Documenting all your services through electronic digital submission also reduces the bottleneck of data entry and helps you get your claims processed faster. For data accuracy and timely visibility, be upfront about asking your providers to document their services electronically. Significant challenges also bring great opportunities for change; utilize COVID-19 interruptions as a change catalyst across your district.
Make Sure Service Logging Solution is Easy
Even during good times, we hear from districts that, on average, 20% of services conducted do not get claimed. The reasons are either the system they are using is confusing or providers are logging in another system and cannot get data into their claiming solution. When you choose a Medicaid Workflow solution, service logging is flexible and minimizes the number of clicks needed to complete a log.
If service logging is happening in additional solutions, try to meet the providers where they are instead of changing their current workflows. To do this, you will need to work with a Medicaid vendor that has proven to import data from various systems such as the SIS, IEP, or nursing EHR solution.
Train and Retrain Your Team
Ensure that your Medicaid staff has gone through the proper training and fully understand what timelines and office procedures they need to follow in order to get claims received successfully.
School districts across the country have not avoided the Great Resignation. In a study completed by Education Weekly, principals say they are working 10 hours a day while district leaders report putting in an average of nine hours daily. This burnout is leading to school Medicaid administrators quitting their positions and leaving claim reports unfiled. Therefore, your district needs to have a documented Medicaid playbook tracking services for reimbursement process workflows.
The playbook should outline roles and responsibilities, including documents required to ensure the program is compliant and meets all business rules (including parental notification and parental consent). Having this information ready enables another staff member to pick up where their colleague left off quickly.
Advocate and Stay Informed Within Your State
Change in Reimbursement Rates
As a result of the pandemic, many states have temporarily increased FMAP percentages, which allows for an increase in payment to school districts. The State is calculating these payments, and districts do not need to do anything to receive these increases in revenues.
A Rise of Telehealth Appointments
As social distancing measures were put in place, the country saw a significant rise in telehealth appointments in schools. Previously, many states did not allow school Medicaid reimbursement of these virtual services but that has begun to change.
Take Connecticut, for example. Before 2020, the State did not allow for reimbursement for school telehealth services. However, during the pandemic, this restriction was lifted and revenues were now being captured. During this time period, other states followed suit in approving telehealth appointments providing revenue streams for schools.
So, what does this mean for your district? You could very well be missing out on additional dollars for your Medicaid reimbursement. Check your state’s rules around telehealth services. These rules have likely changed because of disruption from COVID-19.
No dollar left behind.
As an intuitive Medicaid Workflow Solution, CompuClaim utilizes our software solutions to help you keep records of all your electronic documentation. We ensure that no Medicaid dollar gets left unclaimed for education service agencies, school districts, and school boards. If you are considering a new vendor, check our recent blog on things to consider. To learn more about our services and how we can drive positive results for your district, contact us for a consultation.