A New Paradigm in Medicaid Billing ESA Programs and Services that Make a Difference to LEAs

Transcription

1 A New Paradigm in Medicaid Billing ESA Programs and Services that Make a Difference to LEAs High Plains Regional Education Cooperative 101 North Second Street, Raton, NM Visit:

2 Objectives - Provide an overview of our new Medicaid billing system - Discuss how the system has changed how we bill Medicaid - Demonstrate the system - Discuss the advantages of the system for increased compliance and cost savings - Questions and answers

3 High Plains Regional Education Cooperative HPREC is located in northeastern New Mexico HPREC is one of nine regional education cooperatives in New Mexico HPREC provides regional educational services to eight school districts in Colfax, Union, and Harding Counties, including the billing of Medicaid School Based Services (MSBS)

4 The Vision A solution for school-based Medicaid billing that would: Interface with our SIS and web-based IEP system Increase compliance/reduce errors Eliminate redundancy Increase revenue

5 Critical Features Increase compliance and decrease errors with embedded business rules, including the billing of services only: - Linked to current IEPs (type of service, units of service) - With parental consent - Rendered by providers with current licenses - Coordinated with Primary Care Physician (or documented Good Faith Effort)

6 Enhancements Supervision Report Features Electronic Signatures

7 The Old Process* Related Service Providers: 1. Record services rendered in IEP software 2. Print hard copies, sign, along with supervisor (as appropriate) 3. Deliver or mail to Medicaid office * Items in BLUE are eliminated with the new process by integrating with automated business rules.

8 The Old Process* Medicaid Claiming Manager: 1. Confirm student Medicaid eligibility via New Mexico Medicaid portal 2. Confirm services rendered with services promised in IEPs (current method includes review of individual student folders) 3. Enter services into State billing software 4. Download reports weekly 5. Reconcile submitted claims vs. paid claims, which involves multiple steps * Items in BLUE are eliminated with the new process.

9 The Old Process* Medicaid Claiming Manager: 6. Troubleshoot unpaid claims, make adjustments and resubmit 7. Compile district specific reports for direct billing share * Items in BLUE are eliminated with the new process.

10 The New Process Related Service Providers 1. Record services rendered in IEP software 2. Sign electronically (including supervisor, as appropriate) Medicaid Claiming Manager 1. Evaluate and monitor fully automated system 2. Troubleshoot unpaid claims, make adjustments and resubmit 3. Export district specific reports for direct billing share

11 MeduClaim System Flow

12 Compliance: The Medicaid Tool Kit CompuClaim provides your district a Tool Kit to establish and maintain compliance with State and Federal laws and regulations: - Preserve Institutional Knowledge - Create Medicaid Action Plan - Map out Staff Responsibilities - Continuous Support - HIPAA and FERPA

13 LET S TAKE A LOOK

14 In Summary The MeduClaim Self-Billing Portal: - Maintains the highest levels of compliance - Provides easy access to documentation for auditing purposes, and - Employs user-friendly processes to submit each claiming opportunity.

15 In Summary - The MeduClaim Portal dramatically cuts processing time and costs by as much as 70% thereby reducing district processing costs or eliminating the need for a third party Medicaid billing vendor entirely. - CompuClaim s billing solution (billing, software and technical support) allows a district to MAXIMIZE claiming opportunities with the confidence of meeting compliance regulations.

16 Who Is Compuclaim? One of the leading providers of Medicaid billing and electronic data interchange solutions 20 years of School Based Medicaid billing Connection between over 100 schools districts and Medicaid Minimizes compliance issues Maximizes reimbursements

17 CompuClaim Contact Information Ron Carrington National Director of Sales and Marketing CompuClaim, Inc N. Dysart Road Suite Litchfield Park, Arizona

18 QUESTIONS AND ANSWERS

19 Checking Medicaid Eligibility

20 Meduclaim CompuClaim s MeduClaim Medicaid Self- Billing Program is designed to: - leverage the cost effectiveness of web-based special education data collection tools with Medicaid billing - provide districts an automated system to manage and track the flow of claiming data - reduce current Medicaid processing costs - increase compliance