Simpler Medicaid Billing
Why the School District of Pickens County uses Frontline School Health Management to keep electronic health records and simplify documentation for Medicaid reimbursement.
Easley, South Carolina
Product & Solutions
The school nurses in the School District of Pickens County (SDPC) are busy.
In recent years, the rural district in South Carolina has seen an influx of students from other countries. Many are from families of migrant workers, and as the county welcomed more economically disadvantaged residents, Director of Health Services Angela Watson says that school nurses are often leaned on for routine health care. “When you’re in a county where the poverty rate is high, a lot of the things that the nurses see are things that parents would typically take their child to the doctor for: ‘Look, we’ll go see the school nurse and see what she thinks first.’”
In one of their middle schools, Angela says, it’s not uncommon to see more than 100 health room visits per day. “Of course, I have two nurses there. Most of the nurses see at least 30 students a day. At least. And most of them, much more than that.”
That means keeping adequate documentation was more difficult, and as more students on Medicaid have come into the district, the paperwork required for Medicaid billing was piling up. In the early 2000’s, Angela says that Medicaid billing was overwhelming, and the SDPC didn’t recoup all of the funds they could have.
“The nurses were maybe billing on five or six kids a day because we were doing it on paper, and they could have billed on 20. So when we started looking at that, that’s when we decided to go to electronic health records.”
The district began using Frontline School Health Management — known at the time as HealthOffice — to keep electronic health records and make Medicaid billing easier.
“Electronic health records have so many more benefits than paper documentation,” says Angela. “If the [Frontline School Health Management] system wasn’t here, we would be back putting stuff in notebooks, just writing down a time. And of course, there’d be no accountability there at all.”
Easier Medicaid Billing
In the first year using the system, Angela says the district’s Medicaid billing quadrupled, then doubled again the following year. “Not only did it save money, it made money for us. So that’s the huge part. Medicaid billing is the huge part that has been the most beneficial for us.”
“Not only did it save money, it made money for us…Medicaid billing is the huge part that has been the most beneficial for us.”
– Director of Health Services
With Frontline, nurses can capture more services and document care more accurately. Rather than keeping detailed notes only for students who are on Medicaid, nurses keep records for all students they see, and Angela handles the billing through the system. “We just took that off their plate. They weren’t having to worry about it, yet we were still capturing more students.”
Angela says now that Medicaid billing is no longer done on paper, she can reallocate staff. “Before we had the electronic health record and we were paper billing, that had to go through about three different people. Instead of using nurses to do that, as we grew, I was able to put those positions back in a school as a school nurse and not have to use them for a Medicaid person.”
Immunization Tracking and More
The benefits of a digital system for health records extend beyond Medicaid. “Our nurses were spending a great amount of time on immunizations, keeping paper copies and tickler files of what was due when,” says Angela. “When we realized with electronic health records you could pull a report and see who was delinquent, that was such a time saver for them as well.”
When Angela needs to distribute new emergency care plans, she uses Frontline for that as well, uploading them into the care plan area of the system. Nurses can immediately print them out and distribute them to teachers throughout the district, helping them to keep students with diabetes and other conditions safe.
Angela uses the reporting capabilities in Frontline School Health Management in numerous ways. At the top of her list is the data it provides to help her justify requests for additional nurses. Recently, at the smallest high school in the district, Angela saw that the school’s only nurse distributed 24 daily medications between the hours of 11am and 1pm, leaving no time for anything else. The data helped Angela (successfully) support her request for a second nurse in the school.
Principals also love the data that the system enables Angela to provide. They often request quarterly reports to see which students spend the most time in the health room. “When we’re able to pull that and see that Johnny has, in the first nine weeks, been to the health room 20 times, and you’re sitting in a room with a team and the assistant principal says, ‘Wait a minute, Johnny has also come in late 15 times,’ and then another person says, ‘He’s also been written up four times,’ all of a sudden you start putting all that together and you realize there’s more going on with that student than just asking to go to the health room. It’s great to be able to pull all of that and work together as a team to see what’s going on with the student.”
Angela can also pull reports for the Special Ed department and other teams who might need them. “To be able to pull things for special ed, vision and hearing screenings, treatments, procedures, that has been great as well. We share a lot of reports across the different disciplines in the district.” She has even used the system to pull reports needed for court cases and says that it gives nurses peace of mind knowing that the records are available to show how, when, and why a student was provided with care.
“I cannot imagine a time that we would ever go back to not having an electronic health record.”
– Director of Health Services
Access from Anywhere
The ability to access Frontline from anywhere helps Angela respond to unusual situations. If late in the evening Angela hears that there is a suspected measles case at one of the schools, she can quickly log in and see if any students aren’t immunized, then call and ask them to stay home. “Just having that data at your fingertips helps tremendously.”
Should district operations be disrupted in some way, students will still need care. “If we ever had to leave our campus, if we had to relocate because of a catastrophe or anything like that, all I’ll have to do is pick up my laptop and I can log into Frontline from anywhere and still carry on business as usual. That is a great benefit, and it puts a lot of peace of mind to know that you can carry that with you.”
Justifying the Cost to District Leadership
Angela says that sometimes the district asks if the system is still worth it. “Usually, I’m able to go back and discuss the history of why we went with [Frontline] for our Medicaid billing. And when you look at the amount we bill, it far outweighs the cost.”
When pushed, she has explored other possible options. “All systems look great when they’re selling it. But when you know the questions to ask and you start taking that deep dive into it, so far nothing has been able to give us all the features that Frontline has given us and to be able to pull those reports.”
Some districts have tried other options. “I know a lot of districts have tried to develop their own thing. They’re putting things in a spreadsheet or in Google Forms and things like that to save the cost of having the electronic health record and it never works. They always end up going back to the electronic health record.”
An EHR System to Trust
For Angela, it comes down to reliability and ease of use for her nurses. “I think the heart of this program is to be able to offer my nurses a system that can provide concise and precise documentation that they feel comfortable with and that the district feels confident with. We are able to pull data, pull reports, at the drop of a hat.”
“It’s very important to have an electronic health record that you trust and that once you’ve put that information in, it’s going to be there. You’re going to be able to pull it and be confident that the information’s there and what you’re pulling is accurate. I think that is what keeps customers staying on Frontline.”
– Director of Health Services