Case Studies

Client Profile

Kansas based education cooperative with over 225 participating school districts.

State education cooperative works with Accelify to transition from a bundled-rate Fee for Service claiming process, increasing reimbursements by 230%.

PROJECT OVERVIEW

QUARTERLY MEDICAID REVENUE INCREASE

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For most school districts, in order to claim Medicaid reimbursement for services provided to students with disabilities, each service must be documented and claimed individually.

However, when Accelify began working with our client, the state used an alternative process called bundled rate claiming. School districts were reimbursed a flat fee for each student regardless of how many services were provided to the student in a given month. Although the bundled rate process is very simple for districts to manage, it does not always generate accurate – or auditable – claims. As a result, the federal government mandated that the state’s claiming methodology be replaced with a more conventional process. Our client was experienced in the development and submission of bundled-rate claims, but lacked experience developing and managing the more involved process of documenting each service, so they partnered with Accelify to guide them in implementing the new claiming process for the 225 school districts under contract. Accelify quickly determined that based on timely filing limits for submitting claims for the prior school year, a multi-phased approach would be necessary. This included the development of paper forms for the first phase of documenting services, data entry into a temporary billing system, and the roll-out of a Kansas-specific AcceliTRACK/AcceliCLAIM system for long-term documentation and claiming. Accelify also provided all the necessary training to ensure providers adopted the new tracking system with open arms. The system was up and running to meet the federal mandate and the results speak for themselves.

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RESULTS

When Accelify was brought on board participating school districts predicted that their Medicaid claims would total $4mm-5mm annually. However, utilizing AcceliTRACK to capture services, school districts in the cooperative were able to generate nearly $10mm in Medicaid reimbursement. In our second year we helped the districts generate just under $12mm, and in year three they recouped $13.1 million in Medicaid reimbursement.