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Accelify Client Success

August 18, 2014

THE CLIENT: School District in Virginia

THE PROJECT: Fee-for-Service Medicaid Billing

SITUATION:

Prior to contracting with Accelify, our client had only been billing for occupational, physical, and speech therapy services. Virginia’s school-based Medicaid program covers many other services such as nursing, personal care, social work, psychology, and transportation. With over 1,000 Medicaid-eligible special education students, the District was losing a substantial amount of reimbursement revenue because it lacked a comprehensive and user-friendly solution to capture data for all eligible services. As such, they decided to terminate their contract with their previous vendor and hire Accelify to assist in expanding the Medicaid reimbursement program and to decrease self-audit findings that had not been rectified by its previous vendor – specifically ensuring services being submitted for Medicaid reimbursement were properly authorized in the students’ IEP.

SOLUTION:

Accelify senior management met with District staff to perform a top down needs assessment of the entire Medicaid claiming program and department as well as the work done by its previous vendor. Primary focus was paid to the following areas:

  • Synching data with the recently purchased IEP system to ensure claimed services were properly validated against the IEP data.
  • Implementing missing procedures such as the collection of parental consent and provider licensure information to properly validate claims.
  • Implementation of systems and procedures to allow missing reimbursement opportunities such as psychological and social worker services, personal care services, nursing services and transportation services.
  • Increasing audit compliance for all documentation necessary to submit claims for Medicaid reimbursement.
  • Assessing and addressing inconsistencies and vagueness in VA regulations and manuals that serve to guide districts on proper claiming activities.

Following those needs assessments, Accelify’s operations team begin implementing a multitude of solutions to address our client’s needs. Accelify implemented its AcceliTRACK, AccelACS, and AcceliROUTE systems to maximize the District’s billing ability, allowing them to capture data on all IEP-related health services delivered to students. This included identifying eligible services and providers, conducting a series of Medicaid and system trainings for providers who had not billed Medicaid before, and working with the District’s IEP vendor to integrate AcceliTRACK with their existing IEP system for streamlined case management and end-to-end compliance tracking.

In order to claim personal care services (PCS) in Virginia, services must be recorded using a specific and detailed time sheet format, and must be approved by the supervising health practitioner. To simplify this process and encourage documentation, Accelify implemented the AccelACS system. AccelACS imports PCS assignments from the District’s IEP system and generates time logs that can be printed directly from the system. Accelify reviewed the time logs with DMAS to ensure they met the state’s parameters. Medicaid-required data from the log is parsed into electronic format and used to create Medicaid claims. A scanned copy of the original form is stored in the system for instant retrieval in the event of an audit or state review.

To ensure that transportation services were accurately captured so they could be claimed, Accelify implemented AcceliROUTE. AcceliROUTE integrates with the District’s IEP system to synchronize student and IEP authorization data and imports data from the District’s transportation routing system each week in order to create weekly bus attendance logs. These logs are printed directly from the system and distributed to drivers, who track student attendance. Forms are then scanned back to AcceliROUTE where data is parsed into electronic format. Ridership data is automatically compared to paid claim data for direct services to identify transportation services eligible for reimbursement. Eligible trips are built into X-12 claim format and submitted to the state for reimbursement.

Accelify also conducted a review of the District’s cost reconciliation reports. Accelify was able to provide guidance on adding over a hundred new providers to staff and cost pools as well as identifying several different costs directly attributable to its FFS program to include in its reimbursable expenses. In addition, data from the AcceliROUTE system allowed the District to document and seek reimbursement for transportation costs associated with its Special Education population.

Accelify also facilitated several meetings between the District, VDOE and DMAS to address inconsistencies in programmatic guidance that were causing schools to unnecessarily reduce their claims. Accelify was able to provide guidance in how to reconcile these regulatory inconsistencies in a way that allowed our client to properly document services to be in compliance with both State and Federal guidance.

RESULTS:

The new solutions for capture nursing, counseling, psychology, personal care, and transportation services – all of which were previously unclaimed – were fully implemented during the 2012-2013 school year. In addition, the necessary adjustments to the cost reporting were also implemented. Based on these programmatic changes, out client’s Medicaid reimbursements have grown over 300% since starting its work with Accelify.