Medicaid Billing Office Medicaid Billing Program Overview Case Manager IEP Coordination Training SY...

Medicaid Billing OfficeMedicaid Billing Office

Medicaid Billing Program Medicaid Billing Program OverviewOverview

Case Manager IEP Coordination Training SY 2009-2010

Medicaid Billing Office

Let’s Begin With…

A Medicaid Billing Overview Q/A StyleConditions for Billing Medicaid

Services billed must be provided to a Medicaid- eligible student (under age 21) Services must be provided to a student with an active IEP A current parent permission form A case management notification letter Services must be provided by a qualified practitioner Services billed must directly relate to the goals and objectives of the IEP Have documentation that supports the services being billed

For more information, refer to page 1& 2 in the MA Billing Training Manual.

What are the requirements to bill for Medicaid?

Parent permission is federal requirement and must be obtained prior to submitting billing for reimbursement. Parent permission is valid for one year from the date that it was originally signed; therefore, parent permission must be renewed on an annual basis.

Case Management Notification is a federal mandate requiring that parent/guardians must be notified of the special educator serving as case manager for the implementation of their child’s IEP services. When the case manager changes, the parent/guardian must be notified of this change as well.

We lose $150.00 dollars per form for every month that permission is expired. In FY 2009, the Medicaid Billing program lost over 1 million dollars due to expired permission.

For more information, refer to page 2 in the MA Billing Training Manual

Why is parent permission and case management notification so important?

Who Can Submit Medicaid Forms?

The teacher or a related service provider serving as the student’s case manager must hold a current MSDE issued teaching certificate (Advanced Professional Certificate, Standard Professional Certificate or a Conditional 2-year Certificate) in order to submit billing for Medicaid reimbursement .

Reference (s): COMAR 13A.12.04 and page 2 in the MA Billing Training Manual

What is Service Coordination/Case Management Services?

Service Coordination is defined as case management servicesthat assist students’ in gaining access to services that are recommended in his or her IEP.

The case manager will monitor the delivery of the student’sgoals and objectives and ensure that they meet the student's current needs.

For more information, refer to page 2 in the MA Billing Training Manual

What case management services are billable?

The following are billable ongoing case management services:

Development of the initial IEP ($500.00) Annual Review/IEP Team Meetings ($250.00) Service Coordination ($150.00)

More:

At least one contact per month by service coordinator in person, by telephone, or by written progress notes or log with the participant or the participant’s parent, on the participant’s behalf relating to the child’s ongoing service coordination;

Acting as a central point of contact relating to the IEP services for a participant; Maintaining contact with direct service providers, as applicable, which may

include contact with the student’s parent/guardians through written notes, telephone calls, school visits, and follow-up services as necessary;

Assist with the implementation and access to IEP by coordinating services with service providers, the participant/ student and parents;

Coordinate ongoing monitoring of the IEP by discussing with service providers the services needed and identify any obstacles to utilization of these services.

For students age 6 and under, all service coordination services need to be communicated to the parent/legal guardian.

Reference: COMAR 10.09.04.B. and pages 2 & 3 in the MA Billing Training Manual

What are the Responsibilities of the Case Manager?

Review student list for accuracy. Communicate any changes to the Medicaid Billing Office

by phone 301-952-6349, fax 301-780-5925 or e-mail. Ensure parent permission is current. Complete a new Case Manager letter for any new student

assigned to your caseload. Review your completed forms before returning it to the

Medicaid coordinator for your school. (signature, dates, teacher certification, and any attached documentation.)

Return all reviewed and completed forms to your Medicaid Coordinator or their designee, before the assigned due date.

Inquire about any communications to the case managers from mailings and e-mails or posted notices.

What are the Responsibilities of the Medicaid Coordinator?

Review the student list for accuracy. Communicate any changes to the Medicaid Billing Office by phone 301-952-

6349, fax 301-780-5925 or by e-mail. Ensure Parent Permission is current. Check the student list to make sure the case manager assignment is current. Guarantee that any new case manager completes a case manager letter. Disseminate IEP Coordination forms and Health Related Services forms. Assign a date that completed forms should be returned to you or your

designee, before the end of the month. Review completed forms for correctness and completeness before returning to

the Medicaid Billing Office. Check each form against the student list to be sure that every form is accounted for.

Send completed and reviewed forms to the Medicaid Billing Office before the 5th of the following month.

Communicate to the case managers all information from mailings and e-mails. Post communications monthly.

More Responsibilities of the Medicaid Coordinator

The Medicaid Coordinator should make every effort to establish quality assurance measures for completion and submission of Medicaid forms. A checks and balance system will alleviate the administrative burden of return forms for school staff as well as for the Medicaid Office.

Additionally, the Medicaid Coordinator should develop an internal checks and balance system to ensure timely submission of Medicaid forms. It is extremely difficult to process forms that have been delayed for several months or more. It creates an administrative burden on Medicaid staff and significantly delays the reimbursement process.


On Our Way…

Medicaid Billing Internal & External Process Overview

Medicaid Billing Office Internal Process Overview On a monthly basis, Student lists, IEP Coordination and Health-Related

Service Record billing forms are forwarded to Medicaid Coordinators for dissemination to special education staff.

All Medicaid billing forms should be completed and submitted to the Medicaid Office by the fifth of the following month.

Case Managers are instructed to return forms for any student that did not receive services during the month. These forms are checked in as received and do not count against the school’s performance.

All Medicaid billing forms are reviewed for accuracy and are checked into our billing check-in spreadsheet by school. Any forms that need correction or clarification are given to the Medicaid Program Liaisons for follow up and/or return to the assigned Medicaid Coordinator.

The Medicaid Billing Office staff tracks and monitors the following elements prior to the submission of claims for reimbursement: case manager notification, parental consent status, provider credentials, and Medicaid eligibility status.


Almost There…

Billing Form Completion & Documentation Overview

How to Accurately Complete the Form

Please refer to pages 9-24 in the MedicaidTraining Manual.

Why are forms sent back?

The Medicaid Office reviews every Medicaid billing form for

completeness and accuracy. Forms are returned when they are incomplete or inaccurate. The following are the most prevalent reasons for forms not being processed:

Case manager’s signature is omitted Service date is omitted Service date listed is a date school was not in session (weekends,

holidays, etc;) Documentation is not attached, is insufficient, or is not acceptable. Date on documentation does not match the date of service. Service date and billing form month do not match. Appropriate boxes are not checked. Case Manager’s certification status is omitted. Case Manager on file does not match Case Manager on record. Documentation date and service date do not match.

What is the process for resubmission of forms?

The process for returned forms is to check the incorrect form out as a “return” by entering the “return date” in the billing form check-in spreadsheet.

Subsequently, incorrect forms are returned with an “Oops form” that indicates the problem or inaccuracy that should be corrected and is forwarded to the school’s assigned Medicaid Coordinator. Once the form has been corrected and returned to our office, the form is checked back in by entering the resubmission date in the billing form check-in spreadsheet.

Note: Incorrect forms never count against a school’s performance.


Finally…

Medicaid Office HighlightsIncentive Funds

As an incentive for participating in the school-based Medicaid Reimbursement Program, schools can earn 5% of its total Medicaid reimbursement. The Medicaid Coordinator as well as SPED staff at each school has discretion on how this money is spent. Incentive Funds Purchase Order Requests Forms are located on our website at: http://www1.pgcps.org/medicaid/

Susy Crump is the contact in our office; please submit purchase orders via fax# 301.780.5925. If you have any questions, Susy’s telephone number is 301.952.6349.

When filling out purchase orders for use with the incentive funds, please remember to add shipping & handling costs when applicable. If there is no shipping & handling costs, please put 0 (zero) on that line.

Due to the failure of schools to follow through with the receiving process, all orders will now be shipped to the Medicaid Office and will need to be picked up by an agent of the ordering school.

Medicaid Office Highlights

On a monthly basis, the Medicaid Office generates and disseminates approximately 3,546 IEP Coordination billing forms. The forms are pre-printed with student demographic information, and are colored-coded to represent specific months.

The Medicaid Billing Office tracks the receipt and reviews every Medicaid billing form for accuracy prior to submission for reimbursement. Annually, the Medicaid Billing Office reviews and processes over 35,000 Medicaid IEP Coordination forms. A large number of these forms were returned for correction, this does not take into account forms that are returned multiple times.

In SY 2008-2009, the Medicaid Liaisons trained 202 schools. Ten schools did not have any Medicaid eligible students.

The Medicaid Billing Office tracks and monitors the licensure and certification for all case managers.

Miscellaneous Information MCHP / MMAF – The Maryland Children’s Health Program

(MCHP) and the Maryland Medicaid Assistance for Families (MMAF) are state sponsored and federally funded health plans available to families without adequate health insurance. If you have families that are interested in learning more, please have the parent or guardian call 1-800-456-8900 for qualifying information. Reimbursement rates for students enrolled in these programs is higher.

Medicaid Record Retention – Case Managers should make a copy of all completed forms, attached documentation and any other pertinent Medicaid documents and file them in the student’s Limited Access File (LAF).

Medicaid Office HighlightsAudit Information Annually, Maryland State Department of Education- Interagency Medicaid

Monitoring Team audits the Medicaid Office’s records to ensure compliance with federal and state regulations. We have significantly reduced the number of findings associated with the Medicaid program. We continue to adjust our process to eradicate findings.

MSDE Monitoring Criteria 2005 2006 2007 2008

Service coordinators are identified by name and parents are notified if a change in provider occurs (10.09.52.03) 63% 79.0% 70.0% 100%

Service Coordination is provided by appropriately licensed/certified professionals (10.09.52.03)

84% 86.0% 89.0% 100%

Parental consent for service coordination is obtained prior to billing for case management services (10.09.52.03) 68% 90.0% 97.0% 100%

Adequate documentation of service coordination (10.09.52.04)

42% 38.0% 46.0% 82%

Medicaid Billing Office Staff

Keceya Campbell-Durham, Medicaid Program Coordinator

Cindy Spiller, Medicaid Program SpecialistPhone: 301-780-5911 • E-mail: [email protected]

Ron Holt, Medicaid Technical Specialist

Jerilyn Brooks, Program Liaison (Northern Area)Phone: 301-780-5912 • E-mail: [email protected]

DeAnna Brown, Program Liaison (Southern Area)Phone: 301-952-6338 • E-mail: [email protected]

Susy Crump, Secretary

Heather Sams, Data Entry Clerk

Main Office: Sasscer Building Rm 201-B1Phone: 301-952-6349 • Fax: 301-780-5925Website: http://www1.pgcps.org/medicaid/

Medicaid Billing Office Medicaid Billing Program Overview Case Manager IEP Coordination Training SY...

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