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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
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