1. Four Powerful Strategies to Uncover the Full Potential in Your District’s Reimbursement
Add bios, session objectives, remove company logo
November 8, 2018

2. About the Presenter
Julie Accorsini has worked for Collier County Public Schools for the last 10 years as the district’s Medicaid Manager. During her tenure with the district, she has tripled FFS (fee-for-service) reimbursement levels through the expansion of services billed and addressing cost factors that impact billing rates. Additionally, she has developed the district’s handbook for Medicaid FFS and SDAC (School District Administrative Claiming) and implemented standards and policy controls to ensure compliance for both the FFS and SDAC programs. Prior to joining the school district, Julie held various financial service positions with private corporations.
November 8, 2018

3. Administrative Claiming Program Success01
Introduction
Four Strategies
Administrative Claiming
Program Success 02 03 04
November 8, 2018

4. Four Strategies
November 8, 2018

5. Four Strategies Understand the system Clean up Processes
Strengths
Weaknesses
Clean up
Processes
Medicaid Reimbursement Potential Realized
November 8, 2018

6. Clean Up Eligibility Documentation of therapy sessions Billable staff
Self-audit of billed therapy sessions
Self-audit of paid/denied claims
Clean up – review/develop/implement -procedures/process/compliance needs
Eligibility – data used? Other data available? Example: hyphenated last names.
Documentation of therapy sessions – compliant? Entered timely? IEP documents?
Billable staff– who are they? Other possible billing staff? Certifications needed? Any paid by grants?
Self-audit of billed therapy sessions – Medicaid#/IEP service/billable therapist/compliant documentation
Self-audit of paid/denied claims
November 8, 2018

7. Understand the System Strengths Weaknesses Automation Controls
IEP Integration
Data extracts/formats
Transportation
Weaknesses
Eligibility
Paper documentation (just say no!)
Lack of reports
Non-compliant documentation
Understanding the system-Strengths
Automated process –Integrated with the IEP program.
Extracts data and formats into 270/837 files for upload.
Matches transportation with other service (SLP/OT/PT) and extracts billing.
Understanding the system – Weaknesses
Weakness-eligibility process- typos-name-DOB/hyphenated last names
Lack of billing reports
Inability to track non-compliant documentation
Paper documentation-need for D/E staff
November 8, 2018

8. Processes Get your ESE department on board Think outside the box
Understand the process; ESE vs. FFS
Importance of the program
Financial benefits
Billable vs. non-billable
Documentation/compliance requirements
FAPE – Free Appropriate Public Education
Districts are required to provide services
Many disabilities are health related
Think outside the box
Understanding the ESE (Exceptional Student Education) process vs the FFS (fee-for-service) process –How can we work together?
Why the Certified School Match Program is important? $$$$$!!!
Who benefits from this money?
Billable vs. non-billable events
Documentation/compliance requirements
FAPE- Free Appropriate Public Education
Requires districts to provide services for children with disabilities to succeed in school
Many of these disabilities are health-related
Think outside the box
November 8, 2018

9. Processes Educational Model vs. Medical Model
Medicaid model in an educational environment
Medicaid definitions
Services are needed for success in an educational environment
Educational Model vs. Medical Model
Certified School Match is a broadly defined medical model in an educational environment
Medicaid defines speech, OT, PT, behavior, transportation, and nursing as medical services
These services are needed for children with disabilities to attend/succeed in an educational environment.
November 8, 2018

10. Optimize Revenue Compare district revenue Speak with districts
Student population
Percentage of ESE students
MER
Speak with districts
Billing processes
Approaches
Findings
One of the first things I did was go online and look at what other school districts were billing. I looked at the student population, the percentage of ESE students, and the Medicaid eligibility rate for the applicable county.
I reached out to similar school districts for information about their billing process and approach to maximizing revenue.
November 8, 2018

11. Optimize Revenue Findings Paper process using data entry clerks
Not billing transportation
Not billing for School Health Aides (ESE Assistants)
Not auditing documentation logs
Misperception of the program by administration
Nurses not involved in IEP development
One of the first things I did was go online and look at what other school districts were billing. I looked at the student population, the percentage of ESE students, and the Medicaid eligibility rate for the applicable county.
I reached out to similar school districts for information about their billing process and approach to maximizing revenue.
November 8, 2018

12. Optimize Revenue Questions to ask
How much did we recover last year? The last four years? Why do the numbers change?
Are there ways/places we can recover more funds?
Why were our denied claims rejected?
Why did we have to pay back money on our audit?
How does our revenue break down:
Are our providers documenting everything they can/should?
By service
By school/program
Are the providers documenting in an efficient manner?
By Provider
By students
November 8, 2018

13. Florida Medicaid in the Schools
November 8, 2018

14. Examples Florida Matrix of Services Interpretation Perception
Determines the dollar amount for each student
Based on disability
Interpretation
Perception
Cost of services
Apply for higher rates
Salary/Benefits
Supplies
Nursing services on the IEP was my biggest hurdle!
Florida Matrix of Services – What is it and how does it impact the IEP process and Medicaid billing?
Drives the FTE for students (how much money each district receives for each student)
Level of matrix services based on the disability and needs of student for FAPE
Interpretation –
Nursing services cannot be on IEP without it being on the Matrix – true but….....
Nursing services must be provided by a nurse
Perception –
But DOE says.... Everything ESE does is driven by DOE. The perception is that if DOE not require it then the ESE Department does not need to do it. Not true – example – goals on IEP for students with.....???. Problem-Medicaid requires it so must provide.
Why should we allow the district to “make money”? This is a reimbursement program not a REVENUE program. The costs of services far exceeds the reimbursment levels.
Cost of Services
Apply for higher rates- CCPS currently has higher rates for transportation and nursing
Transportation – probably most overlooked for increased rate potential. (show spreadsheet)
Supplies (fuel, diesel,etc) can be included when calculating an increased rate.

15. Administrative Claiming
November 8, 2018

16. Administrative Claiming
RMTS
Support Staff
Job Descriptions
New Positions
Contracted Staff
Administrative
Claiming
Random Moment Sampling –
Required for School Administrative Claiming.
Selected staff documents what they are doing at a specific date and time.
Usually lacks detail. “in an IEP meeting”. What were you discussing at this time?
Random sample responses impact the reimbursement rate for the claim. Historically, Florida districts have not done well in maximizing the SDAC.
Support Staff
Review job descriptions for applicable staff each year
Review for job listing for new positions
Verify with ESE Department any contracted staff

17. Successes ©2016 Frontline Education Confidential & Proprietary
November 8, 2018

18. Collier Successes Transportation Rate Tripled Nursing Rate Doubled
Do you qualify for a rate increase?
Nursing Rate Doubled
Are you eligible for a rate increase?
Support Staff
School Health Aides
Transportation Rate – process is complicated and time consuming, but the return is worth it. Most school districts will qualify for a rate increase.
Nursing Rate – If nurses (or any other billable staff) are contracted staff, you may be eligible for a rate increase.
Support Staff – School Health Aides that provide health monitoring/management in the classroom. CCPS has 150 SHAs and bills for approximately 40. Last year, we received $96,000 for FFS for SHAs.

19. Collier Successes Medicaid Transportation Rate Instructions
Fleet insurance
Other direct costs
Approved indirect rate
Bus listing
Fleet costs – Function 7800
Bus mileage
Worksheet
Other vehicles - staff
Payroll data
Payroll cost allocation for unassigned drivers/attendants
Abatements
Journal entries – Payroll
Vehicle depreciation costs

20. Collier Successes Nursing Who to include? What costs are reported?
Hours reported
Indirect rate
Eligibility calculation
Total ESE Medicaid students divided by total ESE population
Cost reports 1)
Who to include?
Include all treating providers (employees or contractors) that were paid from Fund 100 and provided the service
during the reporting period. 2)
What costs are reported
All Fund 100 direct costs that are incurred by the individual in the cost report.  The districts accounting system
must have the expenditure by  persons name.Direct costs may be salary, benefits,  travel, communications,
the individual certification costs and medical supplies if the system identifies 3)
Hours reported
Each salary or contractor expenditure must be accompanied by the actual hours paid through Fund 100. 4)
Indirect rate
The current indirect rate as approved for school districts is the IDEA restricted and unrestricted.  5)
Eligibility-How do you compute?
Total ESE Medicaid students divided by total ESE population
INSTRUCTIONS FOR COMPLETING THE COST REPORTS:
(A) Cost Information needed for all district staff and or contracted personnel (object 310) paid from Fund 100
        who were QUALIFIED to provide the services (procedure codes as identified) and actually delivered one
       or more services during the reporting period. Annual actual salary, benefits and hours paid per treating
       provider must be used to eliminate the 10 month/12 month bias.
(B) The employee's unique identification number.  Do not use the SSN.  This could be a district position or
      budget number. 
(C)  Type of person: E is employee, C is hourly contracted, or district defined
(D)  Actual total salaries (object 100) paid from Fund 100 to individual during the period.
(E)  Actual total benefits (object 200) paid from Fund 100 to individual during the last fiscal year.
(F)  Fund 100 other direct costs *
(G) Outside contractor cost per hour paid from Fund 100.
(H) Sub-Total Fund 100 costs
(I)  Applicable indirect Rate
(J)  Total fund 100 Costs
(K) Annual Fund 100 Hours
(L) Hourly Fund 100 Costs
Hourly costs are averaged to obtain the final hourly cost for reimbursement purposes.
* Other direct costs from Fund 100 directly attributed and identified to the employee e.g., travel, direct medical
communication devices and certification  costs may also be included as allowable costs.
Do not apply the hourly cost to the individual procedure codes.
That will be done in Headquarters.

21. Collier Successes
In 2009, CCPS received approximately $230,000/year in FFS and $850,000 in SDAC
By 2010, CCPS was collecting $600,000/year for FFS and $950,000/year for SDAC
Today, the district’s average reimbursement levels are $800,000 (FFS) and $1,000,000 (SDAC).
November 8, 2018

22. Compliance Approach to compliance 100% compliance is the focus
Begin the program with a compliant process
IEP Medicaid Checklist
Make parental consent standard form in all IEP packets
Document all services for all students
Set up monthly reminders (license, Service expirations, etc.)
Automate as much as possible
Revenue
Effort
Compliance

23. Questions?
November 8, 2018

24. Julie Accorsini Medicaid Manager, Financial Services
Collier County Public Schools
Phone:
November 8, 2018