Common Billing Issues for Schools Common Billing Issues for Schools Claiming Medicaid ReimbursementClaiming Medicaid Reimbursement

Tony Boaz, DirectorMedicaid 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

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

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

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

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

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

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

More Clouding

Slow Federal legislative movement regarding the elimination of MAC programs (as well as other proposed cuts)

State laws implicating schools and Medicaid

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.

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