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Ask Me Anything:
Medicaid Edition

 

 

The regulations related to Medicaid can make it a complicated process for districts.

Still, the revenue from reimbursements is critical for district budgets.

Frontline has a team of experts who are experienced with all of the challenges associated with Medicaid billing. What are some of the questions that have come up in recent conversations with clients, and how would they answer them?

Aurora Villareal

Aurora Villareal

Compliance Specialist

Mary Baranowski

Mary Baranowski

Professional Services Consultant

Dzeraldina Zigic

Dzeraldina Zigic

Professional Services Consultant

Stephanie Lawrence

Stephanie Lawrence

Medicaid Client Manager

April Shaw

April Shaw

Medicaid Client Manager

Lynda Womack

Lynda Womack

Professional Services Consultant

Casey Gayer

Casey Gayer

Director of Services, Student Solutions

Interview responses have been edited for clarity and length.

What does the expansion of Free Care mean for states?

Aurora

Aurora: The policy shift that occurred in 2014, Free Care Expansion, allows School-Based Medicaid to expand its state’s program: service areas, other student plan types, and provider types. With the expansion, school districts can gain more reimbursement for services that were previously prohibited from billing because they were not based on an IEP.

You can learn more about Free Care here

How has Frontline prepared to handle changes that may come to state-level Medicaid rules and regulations?

April

April: Every member of Frontline’s Medicaid team stays up to date and informed on new regulations, and, when needed, gets answers to clarifying questions from state Medicaid officials. As a company that supports Medicaid billing in a diverse array of states, Frontline has vast experience with all of the changes that a district might face, and is always ready to quickly update Frontline Medicaid & Service Management to comply with those changes.

Aurora

Aurora: In addition to the Frontline team staying up to date on regulations, we communicate relevant changes to our clients, too. For example, we send consistent email updates to clients regarding school-based regulatory updates for their state, and every client has a designated monthly meeting with their assigned Frontline representative during which they can review claims, ask questions, and any potential additional revenue opportunities.

What trends are occurring in Medicaid?

Mary

Mary: My top three: the focus on the expansion of Free Care, Federal Audits of state practices, and Rehabilitative Behavioral Health Services (RBHS) claiming for mental health.

Aurora

Aurora: It’s all about Free Care for me. There are trends happening within Free Care expansion. Ordering, Prescribing, and Referring (OPR) providers are having to register for a National Provider Identifier (NPI), and/or enroll with their state Medicaid as an OPR provider. These ORP providers’ NPI are also required on the claim line when submitting services and/or evaluations. The Mental Health service area is expanding with new providers, services, and/or evaluation services.

Good to Know:
NPI Registry Public Search is a free directory of all active National Provider Identifier (NPI) records. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry.

How can districts prepare for changes that may occur in their state over the next few years?

Aurora

Aurora: To start, I would focus on updating job descriptions and NPI requirements along with updating parent consent forms to reflect non-IEP services. And knowing that Free Care is one of the most common changes coming to districts, it would be in their best interest to implement universal documentation at the district level when your state plan amendments are approved. That way, you can claim any expanded services, provider types, and student plans.

What can most districts do better?

Lynda

Lynda: Districts are under a lot of pressure due to Medicaid’s compliance and budgetary implications, but here are a few things that come to mind that would benefit districts the most:

  • Standardized practices and universal documentation to ensure that IEP’s are audit-compliant.
  • Refer to your state’s Medicaid manual — in Texas, it’s the Texas Medicaid Provider Procedures Manual (TMPPM) — for guidance on the required documentation.
  • Have a person dedicated to overseeing the Medicaid program, and make sure they work closely with your vendor to maximize revenue (your vendor should be able to help you spot reimbursement potential!).

What one thing can district leaders do to support their district’s Medicaid program?

Stephanie

Stephanie: The first thing that comes to mind is budgeting and appropriation of funds. Making this a proactive process is key. Secondly, staffing federally funded positions has implications for requesting reimbursements, so it’s in your district’s interest to prioritize those. Lastly, participant lists come to mind. Those lists of your service providers can feel tedious, especially if your district experiences a lot of turnover. Keeping those up to date can be crucial in making sure billing goes smoothly.

If you could wave a magic wand what is one thing you’d wish for all Medicaid program administrators?

April

April: No staff shortages!

Aurora

Aurora: No turnover! But also, it would be wonderful if Local Education and State Medicaid Agencies would host monthly or quarterly meetings on updates. I’d also like to see regulatory update training for program administrators.

What is the most common mistake you see Medicaid program directors make?

Dzeraldina

Dzeraldina: It all comes down to assumptions. Unfortunately, providers aren’t always documenting everything in a way that program directors need them to, so making that assumption can come back to bite the district. Also, if you’re not analyzing the data to ensure that your returns are maximized, you’re likely missing out on potential revenue! Finally, assuming that the student demographic data between the state and their SIS matches.

How can Medicaid directors support new service providers who join the district throughout the year?

April

April: Provide training! The initial investment of time pays off throughout the year.

Mary

Mary: Make sure that new providers know how to utilize their learning centers.

What advice would you offer to a district going through their first cost reconciliation with a new vendor?

Stephanie

Stephanie: This process can be challenging, but here are two things you can do to make it less painful:

  • Understand the data that is needed and ensure the previous vendor provided clear, understandable data that they can use.
  • Request your data from your previous vendor prior to alerting them that you are transitioning to a new vendor.
Dzeraldina

Dzeraldina: If you have a solid understanding of the data flow between your district, your vendor, and the state, you’ll be well-positioned.

Why do some districts have to give money back on a cost report?

Stephanie

Stephanie: If a district gets paid more in Interim payments than their overall expenses related to Medicaid (provider salaries, Medicaid allowable purchases, transportation, etc.) they must give money back to make up the difference.

Want to learn more about cost reporting?
Check this out.

Frontline can help.

Frontline’s team of Medicaid specialists is dedicated to making sure you get every dollar you’re owed while making sure the Medicaid billing process is as simple as possible.

See it in action