Be Prepared for a School Medicaid Audit

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The word alone can send chills down anyone’s spine: audit. Now multiply that panic by a few hundred times, and that’s how most school superintendents probably feel when their district is up for a Medicaid audit. Where do you even begin to prepare for an audit of this size? Well, our experts already know the answer to that question (and so many other audit questions!).

There are plenty of “billing companies” in the market, but none that provide such a comprehensive combination of services and electronic product expertise for the unique needs of school districts like Reimbursement from SEAS.  We recognize the districts and their staff complete the “heavy lifting” to successfully maximize reimbursements and obtain compliance, and we are proud to provide them with the tools, support and training to reach those goals.

So when Mesa Public Schools (MPS), one of Arizona’s largest districts and a long-time Reimbursement customer, received audit findings back in 2009 which found missing ‘qualified provider signatures and dates’ on their IEPs, they faced the chance of losing hundreds of thousands of dollars in pending Medicaid claims. During the months-long process of investigating and resolving the missing signatures, the Reimbursement team provided assistance and many specialized services to MPS:

1. Consultation & Training

At the direction of MPS administration, the Reimbursement team at SEAS met with MPS’ legal department to educate them on the overall DSCtop data entry program, which is the Medicaid claiming program provided to our districts for accurate data capture.

2. Research

While researching historical audits to identify any other case where this finding had been discovered, it became apparent that the claims associated with the audited IEPs would expire before we could find a resolution. This was because Arizona requires all claims to be submitted within six months of the service delivery, and due to the timing of the audit findings and when our team began their services, those expiration dates were coming fast. However, denied claims in Arizona have twelve months from the denial date to be resubmitted for payment.

3. Maximization

So they formed a plan: After consultation with the district and the TPA, key data elements were removed from the claims and submitted with the intention that they would be denied. This gave MPS twelve additional months to resubmit these claims. Once the issue was resolved, our team was able to resubmit the claims for payment on behalf of the district.  Mesa received $3,835,789.00 in checks in 2010-11, boosted by the result in having the ability to reprocess the claims.

4. Advocacy & Preparation

One of the outcomes of the issue was the need, moving forward, for MPS  to have specific signatures and dates on IEPs.  Our team went building-to-building along with the MPS administration to locate the right services staff and obtain their signatures and dates on appropriate documents.

Mesa Public Schools were also recently involved in a “special” transportation audit by the AHCCCS OIG Office of Program Integrity to review the Evaluations and IEPs for over 200 students. Our team again worked with MPS to develop a process by which to review documents and report findings in an organized manner, and then reviewed all the documents a final time before submission.  MPS received a compliance rating of 99.86%!

You never have to be caught off guard by an audit. All advocate, audit and maximization support services are provided to our districts at no additional cost when you sign-up for Reimbursement. Call and talk to one of our Medicaid experts today, or send us a message to schedule a FREE demonstration.