HBS — Healthcare Billing Services, Inc.
55 High Street, Carroll, Ohio 43112
Phone: 740/639.4218 • Fax: 740/639.4217
Therapists document services and Medicaid claims are submitted to the Ohio Department of Medicaid (ODM) for those students with a Medicaid number and signed Parental Consent. (Interim Claiming)
At year end, a Medicaid Cost Report is filed that includes therapist salaries, benefits, and contracted service costs. This usually generates additional Medicaid revenue for the district. (Final Settlement)
ODM would prefer that the majority of MSP revenue be paid in the Interim Claiming process and very little paid out in the Final Settlement process. When districts have large Final Settlements they begin to question whether all therapists are submitting claims for all services. As a result of this concern, ODM has made the following rule change.
5160-35-04 (D)(2) – “Costs for direct services for which a provider has not submitted an interim claim will not be paid to the provider in any final cost report settlement”
5160-35-04 (K)(4) – “identify the number of students for which claims for services were received and paid and determine the proportionate costs for those students using the costs from the cost report for the total population of Medicaid eligible IEP students”
Total number of students with a Paid Claim — 75
Total number of IEP Medicaid students — 100
Percent of IEP Medicaid students with claims — 75%
Total Allowable MSP Costs — $100,000
Adjusted Allowable MSP Costs (75%) — $75,000
(In this example a district would lose $25,000 in potential MSP reimbursement)
Therapist did not document their services.
District did not have the parent sign the Parental Consent Form.
“Services by Therapist” report
This report shows how many minutes per month each therapist is documenting.
“List of Students that Require a Signed Consent Form” report
This report shows students with billable claims that could be processed if we had a signed parental consent form.
(These reports are emailed quarterly to whoever is currently identified as our MSP contact person.)
• Review “Services by Therapist” report and question therapists that are not documenting their services.
• Notify parents on the “List of Students that Require Signed Consent Form” report and have them sign a PC form.
We can identify for you what therapists are documenting, but we cannot make them document. We can identify the missing Parental Consent forms, but we do not have contact with your parents. It is very important for someone at your district to monitor and coordinate these two critical areas. We must submit claims for all IEP Medicaid students or risk losing potential Medicaid dollars to your district.