8/13/15: Interim Claiming Cost Adjustment

Our first topic, and probably the most important topic, relates to what we call the “Interim Claiming Cost Adjustment”. The Ohio Department of Medicaid (ODM) added language to the MSP rules that reduces overall MSP reimbursement if Medicaid claims are not submitted for all Medicaid students. This means that if your district has 100 IEP Related Service Medicaid students, ODM expects that Interim Claims are submitted for all 100 students. If claims are submitted for only 75 of the 100 students, MSP reimbursement will be reduced by 25%.

The two main reasons why Interim Claims would not be submitted for all Medicaid students are:

  • The therapist did not document the service.
  • The district did not obtain a signed “MSP Parental Consent Form” (PR-10).

Therapist did not document the service.

All related service therapists (OT, PT, SLP, Psych, Nurse, etc.) must document their ETR Testing and IEP Direct Service for all students. The problem is that many therapists get behind on their documentation and either stop documenting altogether or they miss services or students when trying to catch up at year end. It is extremely important that therapists stay current with their service documentation and document for all services and all students. Quarterly reports are sent to each district that show which therapists are not completing MSP service documentation. It is extremely important that districts follow-up with therapists that are not documenting their MSP services.

Districts did not obtain a signed “MSP Parental Consent Form” (PR-10)

Before Interim Claims can be submitted to Medicaid, the district must have the parent sign the PR-10 form that gives the district permission to share protected health information and bill Medicaid. This form only needs to be obtained one time and is effective as long as the student attends the district. The best time to have this form signed is during the ETR intake process, when the parent is also signing the PR-05 form which gives the district permission to test the student. Quarterly reports are sent to all districts that show students with billable claims that do not have parental consent.

The 2014/15 school year (last year) is the first year that ODM will be making the “Interim Claiming Cost Adjustment”. We have 365 days from the date of service to bill claims, so it is not too late for therapists to catch up on their MSP documentation or obtain signed Parental Consent Forms for last school year. We will continue to send out reports for last school year so that districts can catch up and avoid substantial reductions in their Medicaid reimbursement.