Accelify Client Success
September 25, 2014
THE CLIENT: Kansas based educational consortium and over 225 associated school district clients
THE PROJECT: Fee-for-Service Medicaid Billing
For most school districts in the United States, claiming reimbursement for Fee-For-Service (FFS) requires the documentation of each service provided to a Medicaid eligible Special Education student. Kansas, however, had previously implemented a “bundled rate” methodology. School districts were reimbursed a “flat fee” for each such student serviced to reimburse both the cost of providing health services and associated Administrative costs regardless of how many services were provided to the student in a given month.
Although this “bundled rate” process was very easy for school districts to implement due to its minimal documentation requirements, it does not always generate accurate – or auditable – claims. As such, after a CMS/OIG audit of Kansas Medicaid claims, CMS mandated that the bundled rate methodology be replaced with a more conventional FFS claiming methodology.
While our client was experienced in the development and submission of “bundled-rate” claims, it had no experience in developing or managing the more involved process of documenting each service and did not have a claiming system that would allow for the claims to be built in the new format required by the Kansas Medicaid agency and CMS.
There was an acute risk for districts in Kansas as many were starting to abandon the Medicaid claiming program due to increased workload and decreased reimbursements.
Accelify was brought in by our client to help implement the new FFS claiming system for the 230 school districts under contract. Accelify quickly determined that based on the applicable timeframes and current backlog of claimable services, a multi-phased project methodology approach would be necessary.
Accelify managed the entire transition including:
- Meeting with the Kansas Medicaid agency at the time, Kansas Health Policy Authority (KHPA has since been transferred to KDHE), to gain visibility and insight into new documentation requirements as well as eligibility and claim submission standards and protocols.
- Developing a full needs assessment for the COOP and each of their 225+ member school districts focused on the steps necessary to transition to a FFS claiming methodology and back logged claim data.
- Developing manuals detailing new documentation requirements for FFS claiming and additional documentation required in audits. This was very important in large part because KHPA had not released any manuals or guidance concerning the new FFS documentation requirements, leaving school districts with a potential loss of millions of dollars of reimbursement without any clear guidance on how to properly utilize the new methodology.
- Custom development and testing of a fully compliant electronic documentation and Medicaid billing system within 2 months.
- Creation of paper service delivery logs that were in compliance with KHPA’s documentation requirements.
- Establishment of Fee schedule detailing procedure codes and associated rates for over 225 clients.
- Creation of a local physicians’ network that school districts could use to review student files and issue prescriptions for services required by the new FFS methodology.
- Collection of student demographic data for 50,000 students to supplement the submission of eligibility determination information as districts had not been responsible for eligibility testing under the prior methodology.
- Collection of provider licensure information for over 10,000 providers according to KHPA requirements.
- Data entry of paper service delivery logs to assist districts in submitting services in a timely fashion. The large backlog of claims required additional attention because many were very close surpassing the timely filing claiming limits established by KHPA.
- Training of over 10,000 health care providers in a 45 day timeframe on the new Medicaid documentation requirements and use of Accelify’s Medicaid documentation software.
Accelify was able to implement a fully compliant customized solution within a matter of months. Due to Accelify’s rapid program rollout, districts in Kansas were able to document millions of dollars of retroactive claims that had almost exceeded timely filing limitations. Accelify’s consulting expertise allowed for a smooth transition even though KHPA had no experience with administering a FFS based billing program in school districts.
In addition, Accelify’s expertise and guidance in FFS programs in other states allowed the COOP and the 225+ associated school districts to move forward with a sense of confidence that the new FFS methodology was being implemented properly, which alleviated fears concerning audits of the new program.
Accelify’s work also greatly exceeded school district expectations from a financial standpoint. When Accelify was brought on board, the participating school districts had predicted that their claims would total $4,000,000-$5,000,000 per year. School districts utilizing Accelify’s new Medicaid billing system were able to generate almost $10,000,000 in the first year of the program and an additional $5,000,000 in retroactive claims. The reimbursement figure has continued to increase every year since implementation.