11/05/15: Billing Vendors

I can get your district more Medicaid reimbursement than any other MSP Billing Vendor!

I wish that I could say that, but if I did, I would not be telling you the truth. The bottom line is, HBS cannot get a district any more MSP reimbursement than any other billing agent. We are all playing by the same State MSP Rules and Federal Medicaid Rules. As I have explained before, MSP reimbursement is very straightforward in that your district’s overall MSP reimbursement is computed using Costs x RMTS x MER x FFP.

  • Costs are based on the current MSP billable services (OT, PT, SLP, Audiology, Psychology, Nursing, SW, Counseling, and Specialized Transportation). The Medicaid School Program is several years away from doing any program expansion, so any MSP Reimbursements Estimates that include Targeted Case Management, Delegated Nursing, Personal Care Services, or Intensive Behavioral Services are flat out misleading.
  • The Random Moment Time Study (RMTS) percentage is computed by UMASS, and is the same percentage for all districts.
  • The Medicaid Eligibility Rate (MER) is computed by ODM, and is based on EMIS data submitted by each district.
  • The Federal Financial Participation (FFP) rate is computed by CMS and is the same rate for all Ohio Schools.

With that said, unless the billing vendor is reporting unallowable costs on the MSP Cost Report, no vendor can get you more reimbursement than the other. The Ohio Department of Medicaid, Ohio Department of Education, and the Ohio Auditor of State are aware that some districts are reporting unallowable costs on their MSP Cost Report, so be prepared for more audits and additional changes to the AUP audit. Here are some of the unallowable costs that will lead to major Cost Adjustments:

  • Districts cannot report 100% of their Nursing costs on the MSP Cost Report. You can only report costs associated with nurses that are providing services to IEP Students. Regular School Nurses are not Medicaid reimbursable, unless they are also serving students with Nursing Services listed on their IEP, or nurses that do ETR assessments.
  • Districts cannot include “Travel Costs” on the MSP Cost Report. Service costs are limited to Salary, Benefit, and Contracted Related Service Costs.
  • Billing Agent fees cannot be reported on the MSP Cost Report if they are based on a “Percentage” or a “Flat Fee”. Only billing fees based on a “Per IEP Student” or “Per Claim” basis are Medicaid allowable.
  • Only costs related to Licensed Therapists can be reported on the MSP Cost Report. The Ohio Medicaid School Program does not currently allow for reimbursement for coordination services provided by Special Education Directors or Administrators.
  • Districts can only report Related Service Costs for those therapists that documented all of their ETR and IEP services. If a therapist did not document a measurable amount of MSP reimbursable services, then their costs cannot be included on the MSP Cost Report.

When a billing agent claims that they can get you more money, beware. What sets the billing vendors apart are the quality of services that they provide.

Therapist Service Documentation Software – This is one of the most important things to consider. The MSP rules are very specific as to what elements must be documented. All billing vendors have web-based documentation programs, but they must be reliable and efficient for your therapists to use. The billing vendor must make constant changes to the software application based on therapist needs. We need to always be looking for ways to make the documentation process as efficient as possible for your therapists.

Cost Report Preparation – As equally important is the preparation of the MSP Cost Reports. You can only count the salary, benefits, and the contracted costs of the therapists that actually documented MSP billable services. Getting aggressive with the Cost Report will not only result in owing money back, but it also jeopardizes the entire Medicaid School Program.

Customer Service – When your staff members have a question or problem, they need immediate assistance. State Medicaid rules are different in every state, and it is very important that your staff members have immediate access to accurate and timely information.

Staff Training – As MSP rules change and billing software is modified, it becomes important that your therapists are properly trained. Proper staff training is important to ensure that therapists know exactly what services are reimbursable, what documentation is required, and what program changes have taken place.

Rule Interpretation – Your billing vendor is responsible for understanding both the Ohio Administrative Code as it relates to MSP, and also the Federal rules relating to Medicaid and IDEA. These rules are constantly changing, and updated information needs to be provided to participating districts on an ongoing basis.

Audit Representation – Last week I detailed the various audits that are currently taking place with the Ohio Medicaid School Program. When you are selected for any type of MSP audit, it is important to have your billing vendor assist you with the gathering of information and the review of any audit findings. Your billing agent should know more about the program than the auditors, so many issues can be resolved simply by explaining the rule requirement.

ODE/ODM Collaboration – The Ohio Department of Education and the Ohio Department of Medicaid work very closely with the billing agents that represent the participating school districts. A strong working relationship between these stakeholders is very important to keep this program moving forward.

There are some very aggressive MSP marketing campaigns going on right now around Ohio. Promises of more money and free membership in an association that is run by the billing agent is very misleading. If at any time you have any questions or concerns, we are always more than happy to come to your location and do a “Program Review” for our clients and our non-clients.

As always, please let us know if you have any questions.