Fee-for-Service (FFS) reimbursements can be a significant revenue source. In fact, most of our clients receive between $500 and $1000 per Medicaid-eligible special education student annually.

As with many federal programs, however, the process for claiming Medicaid reimbursements is complex. Districts must properly manage many moving parts to conform to federal and state regulations. Even for large school districts with significant resources, the administrative efforts required to receive Medicaid reimbursements present a challenge. For smaller districts, administration of the Medicaid reimbursement programs is more than a challenge — doing it correctly is next to impossible.

The FFS claiming process begins with a special education student’s IEP. Under current law, if a health-related service isn’t specified (i.e. prescribed) in a student’s IEP, it cannot be claimed.

To create an effective FFS claiming program, a district must

• Stay current on changes to the state Medicaid claiming process
• Stay current on changes to the federal Medicaid claiming process
• Stay current on changes to the state Medicaid plan’s coverage
• Document the IEP itself and the prescriptions for the services specified in it
• Document reception of parental consent for the services to be claimed
• Manage physician prescriptions where necessary
• Maintain, as required, originals and copies of all forms and records

Once services are provided, a district must

• Document that the services were provided
• Calculate the cost of services provided and match them to the state rate cards
• Verify that the student was eligible for Medicaid at the time of service delivery
• Verify that the service was prescribed in the IEP
• Match the service to the parental consent form on file
• Verify that the service was tendered by a properly licensed and certified provider
• Develop/build claims for eligible services
• Submit claims to the state Medicaid agency
• Track claims
• Participate in audits as necessary

If any of the above components are not completed exactly as required, reimbursements can be denied or, even worse, audit findings may require repayment of reimbursement funds already received.

Accelify works hand in hand with school districts to manage the FFS program from start to finish. We have over 20 years of experience with school-based Medicaid, and our team is well versed in all state and federal regulations that relate to special education. We offer customized training programs, full-service support, and proprietary technology to reduce workloads while making sure that your district is taking full advantage of the Medicaid reimbursement program. We worry about the details, so that you don’t have to.